Diagnostic Value of the Updated Diamond and Forrester Score to Predict Coronary Artery Disease in Patients with Acute-Onset Chest Pain

Cardiology ◽  
2015 ◽  
Vol 133 (1) ◽  
pp. 10-17 ◽  
Author(s):  
Mathias Sørgaard ◽  
Jesper James Linde ◽  
Klaus Fuglsang Kofoed ◽  
Jørgen Tobias Kühl ◽  
Henning Kelbæk ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Diagnostic Accuracy ◽  
Stress Test ◽  
Photon Emission ◽  
Acute Onset ◽  
Emission Computed Tomography ◽  
Artery Disease

Objectives: In the recently updated clinical guidelines from the European Society of Cardiology on the management of stable coronary artery disease (CAD), the updated Diamond Forrester score has been included as a pretest probability (PTP) score to select patients for further diagnostic testing. We investigated the validity of the new guidelines in a population of patients with acute-onset chest pain. Methods: We examined 527 consecutive patients with either an exercise-ECG stress test or single-photon emission computed tomography, and subsequently coronary computed tomography angiography (CCTA). We compared the diagnostic accuracy of PTP and stress testing assessed by the area under the receiver operating characteristic curve (AUC) to identify significant CAD, defined as at least 1 coronary artery branch with >70% diameter stenosis identified by CCTA. Results: The diagnostic accuracy of PTP was significantly higher than the stress test (AUC 0.80 vs. 0.69; p = 0.009), but the diagnostic accuracy of the combination of PTP and a stress test did not significantly increase when compared to PTP alone (AUC 0.86 vs. 0.80; p = 0.06). Conclusions: PTP using the updated Diamond and Forrester Score is a very useful tool in risk-stratifying patients with acute-onset chest pain at a low-to-intermediate risk of having CAD. Adding a stress test to PTP does not appear to offer significant diagnostic benefit.

scholarly journals Direct Comparison of Cardiac Troponin T and I Using a Uniform and a Sex-Specific Approach in the Detection of Functionally Relevant Coronary Artery Disease

2018 ◽  
Vol 64 (11) ◽  
pp. 1596-1606 ◽  
Author(s):  
Deborah Mueller ◽  
Christian Puelacher ◽  
Ursina Honegger ◽  
Joan E Walter ◽  
Patrick Badertscher ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Diagnostic Accuracy ◽  
Cardiac Troponin ◽  
Troponin T ◽  
High Sensitivity ◽  
Emission Computed Tomography ◽  
Cardiac Troponin T ◽  
Artery Disease

Abstract BACKGROUND We aimed to directly compare high-sensitivity cardiac troponin I (hs-cTnI) and high-sensitivity cardiac troponin T (hs-cTnT) in the detection of functionally relevant coronary artery disease (fCAD). METHODS Consecutive patients referred with clinical suspicion of fCAD and no structural heart disease other than coronary artery disease were included. The presence of fCAD was based on rest/stress myocardial perfusion single-photon emission computed tomography/computed tomography and coronary angiography. hs-cTnI and hs-cTnT concentrations were measured in a blinded fashion. Diagnostic accuracy was quantified using the area under the ROC curve (AUC) and evaluated both for uniform use in all patients and for sex-specific use in women and men separately. The prognostic end point was major adverse cardiac events (MACEs; cardiovascular death or myocardial infarction) within 2 years. For the prognostic performance, we used a multivariable model comparison with the Akaike information criterion (AIC). RESULTS fCAD was detected in 613 of 2062 patients (29.7%) overall, 112 of 664 of women (16.9%), and 501 of 1398 of men (35.8%). hs-cTnI and hs-cTnT had comparable diagnostic accuracy when assessed for uniform use in all patients (AUC, 0.68 vs 0.66; P = 0.107) and separately in women (AUC, 0.68 vs 0.63; P = 0.068) and men (AUC, 0.65 vs 0.64; P = 0.475). However, women required lower rule-out cutoffs to achieve high sensitivity, and men needed higher rule-in cutoffs to achieve high specificity. hs-cTnI and hs-cTnT were strongly and independently associated with MACE within 2 years (P < 0.001), with comparable prognostic accuracies by the AIC. CONCLUSIONS hs-cTnI and hs-cTnT provide moderate and comparable diagnostic accuracy. Sex-specific cutoffs may be preferred. The prognostic utility of both troponins is comparable.

Abstract 13023: Incremental Diagnostic Accuracy of Hybrid Single Photon Emission Computed Tomography Coronary Angiography in Suspected Coronary Artery Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Shoko Hachiya ◽  
Hisanori Kosuge ◽  
Yasuhiro Fujita ◽  
Satoshi Hida ◽  
Taishiro Chikamori
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Diagnostic Accuracy ◽  
Hybrid Imaging ◽  
Single Photon ◽  
Photon Emission ◽  
Suspected Coronary Artery Disease ◽  
Emission Computed Tomography ◽  
Artery Disease ◽  
Photon Emission Computed Tomography

Background: Single-photon emission computed tomography (SPECT) and computed tomography coronary angiography (CTCA) are often undertaken independently in patients with suspected coronary artery disease (CAD). Hypothesis: We assessed the hypothesis that hybrid SPECT/CTCA imaging results in higher diagnostic accuracy than either method alone, allowing some false positives to be ruled out in the non-invasive testing phase. Methods: A total of 129 vessels (43 patients) were screened by SPECT with cadmium-zinc-telluride semiconductors and CTCA with a 256-detector row CT of the right coronary artery (RCA), left anterior descending artery (LAD), and left circumflex (LCX) segments. Patients who were diagnosed with myocardial ischemia then went on to undertake CAG. A diameter stenosis > 50% and any non-diagnostic segment in CTCA were considered abnormal. CAG results were classified as positive for stenosis when either a diameter stenosis was over 75% or fractional flow reserve was under 0.8. These were then compared to an image fusion of SPECT and CTCA data sets performed on a dedicated workstation. The results were categorised as a match or a mismatch (same as or different to the CAG, respectively). Results: Matched findings at SPECT, CTCA, and hybrid imaging were found in vessels of 75%, 67%, and 92%, respectively. Compared to the individual diagnostic performance of SPECT or CTCA in detecting significant CAD, hybrid imaging exhibited greater results in all of sensitivity, specificity, and accuracy (Fig 1). Segmental reclassification of perfusion abnormalities by hybrid imaging occurred at 10% for LAD, 56% for LCX, and 5% for RCA. Moreover, hybrid imaging allowed for accurate diagnosis of 22 vessels with severe calcification which CTCA alone could hardly evaluate correctly (Fig 2). Conclusions: Hybrid imaging showed higher diagnostic accuracy compared to single modalities, enabling physicians to make better decisions about the necessity for invasive CAG procedure.

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