The Egyptian Journal of Radiology and Nuclear Medicine (Mar 2016)

Estimation of frequency and pretest probability of CAD in patients presenting with recent onset chest pain by multi-detector CT angiography

  • Omar Muayad Sultan,
  • Laith Salh Hamed Al-obaidi,
  • Dunya Burhanaldin Abdulla,
  • Amr Ahmed Mostafa,
  • Ahmed Aboul Fotouh,
  • Ahmed Said Tawfeek

DOI
https://doi.org/10.1016/j.ejrnm.2015.11.008
Journal volume & issue
Vol. 47, no. 1
pp. 111 – 117

Abstract

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Background: Coronary artery disease (CAD) is the single most common cause of death in the developed world, responsible for about 1 in every 5 deaths. The morbidity, mortality, and socioeconomic importance of this disease make timely accurate diagnosis and cost-effective management of CAD of the utmost importance (Cassar et al., 2009; Russo et al., 2010; Dedic et al., 2011). Objectives: The aim of this study was to estimate the frequency and pretest probability of CAD in patients presenting with recent onset chest pain by multi-detector CT coronary angiography as a non-invasive imaging tool. Methods: This study included 40 patients, presenting with recent onset chest pain showing initial negative ECG and troponins enzyme, and they were scheduled for elective multislice CT coronary angiography between March 2013 and September 2013 in Cairo Radiology Center (Cairo Scan). Results: Among 40 patients there were 31(77.5%) had CAD (37.5% significant and 40% non-significant CAD). 29(72.5%) were hypertensive, 27(67.5%) were diabetic, 23(57.5%) were dyslipidemic, 13(32.5%) were smokers, and 10(25%) were with positive family history of IHD. Significant CAD seen in 60% of hypertensive, 70% of diabetic, 20% of those with positive family history, 17% in those with low pretest probability group, 37% in intermediate probability group, and 57% in high probability group. Hypertensive patients showed similar CACS compared to normotensive (275.73 vs. 237, P value > 0.05), and diabetic patients showed higher CACS compared to non-diabetic (328 vs. 179.9, P value 60 years. Conclusion: CAD was seen in 77.5% in those with recent onset chest pain. Higher incidence of significant CAD was seen in hypertensive and diabetic patients. Family history is still not a reliable factor in our society. Male patient <60 years old has higher incidence of CAD than female in same age group. Pretest probability for CAD is a simple and important test as all patients in higher probability have CAD and most of them have significant disease so it is better to direct referral of them to conventional angiography to gain a benefit from direct intervention, radiation and cost benefit.

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