Login
Search
Search
0 Dates
2024
2023
2022
2021
2020
2019
2018
0 Events
CPC 2018
CPC 2019
Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
CPC 2020
CPC 2021
CPC 2022
CPC 2023
CPC 2024
0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
G. Aortic Disease, Peripheral Vascular Disease, Stroke
H. Interventional Cardiology and Cardiovascular Surgery
I. Hypertension
J. Preventive Cardiology
K. Cardiovascular Disease In Special Populations
L. Cardiovascular Pharmacology
M. Cardiovascular Nursing
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
O. Basic Science
P. Other
0 Themes
01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
37. Miscellanea
0 Resources
Abstract
Slides
Vídeo
Report
CLEAR FILTERS
Positive predictive value of computed tomography coronary angiography vs exercise stress test in the diagnose of obstructive coronary artery disease
Session:
Posters 2 - Écran 8 - Doença Coronária
Speaker:
Rui Azevedo Guerreiro
Congress:
CPC 2019
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
12. Coronary Artery Disease (Chronic)
Subtheme:
12.3 Coronary Artery Disease – Diagnostic Methods
Session Type:
Posters
FP Number:
---
Authors:
Rui Azevedo Guerreiro; Antonio; Diogo Brás; Mafalda Carrington; Rita Caldeira Da Rocha; Renato Fernandes; Agostinho Caeiro; José Eduardo Aguiar
Abstract
<p>Introduction: European Society of Cardiology (ESC) guidelines on the management of stable coronary artery disease (2013) suggests a stress test, either treadmill exercise stress test (EST) or, preferably, stress imaging test for the diagnosis of stable coronary artery disease. Computed tomography coronary angiography (CTCA), according to ESC, is reserved as an alternative or after a non-conclusive stress imaging test in a very specific group of patients within the lower range of intermediate pre-test probability. On the other hand, NICE guidelines, from United Kingdom (UK), suggests that new onset stable chest pain patients, as well as those with non-cardiac chest pain and an abnormal resting electrocardiogram, may be offered CTCA, as a diagnostic test.</p> <p> </p> <p>Purpose: Authors aim to compare the positive predictive value of these two very different approaches to diagnose obstructive coronary artery disease: CTCA versus EST.</p> <p> </p> <p>Methods: Audit study including two centres: one in the UK whose patients with stable chest pain are investigated with CTCA and one centre in Portugal whose patients with stable chest pain are investigated preferably with EST. The inclusions criteria were the following: for the UK centre, consecutive patients with stable chest pain referred to CTCA; for the Portuguese centre, consecutive patients with stable chest pain, a positive EST and referred to invasive coronary angiography (ICA). Obstructive CAD was defined as ≥50% stenosis in any epicardial coronary artery. Demographic, CTCA, EST and ICA data were collected. Statistical analysis was performed using STATA v14. p<0.05 was considered statistically significant.</p> <p> </p> <p>Results: 800 patients were included in total, 400 from each centre. Patients from the UK centre were slightly younger (61 vs. 63.7 years, p<0.001) but with similar sex distribution (men: 52.6% vs 58%, p>0.05) and similar BMI (28.9 vs. 28.4 kg/m<sup>2</sup>, p>0.05). In the UK centre, 387 (96.8%) CTCAs were diagnostic. Positive CTCA, defined by obstructive CAD (CAD-RADS 3 – 5), was present in 92 (23.8%) patients. From these 92 patients with positive CTCA, 67 (72.8%) patients were referred to ICA and from these latter, 61 (91%) patients had obstructive CAD on ICA. The positive predictive value for CTCA in our sample was 91%. In the Portuguese centre, obstructive CAD on ICA was present in 205 (51.3%) patients, giving a positive predictive value in our sample for EST of 51.3%. The difference between positive predictive value of CTCA (91%) vs. positive predictive value of EST (51.3%) is statistically significant (p<0.0001).</p> <p> </p> <p>Conclusion: In our study, CTCA had a higher positive predictive value than EST (91% vs. 51.3%). The strategy to use CTCA as first line test to investigate patients with stable chest pain can potentially avoid an important number of unnecessary ICA, driven by the higher positive predictive value of CTCA, when compared to the modest positive predictive value of EST.</p>
Our mission: To reduce the burden of cardiovascular disease
Visit our site