Academic Radiology
Volume 17, Issue 5 , Pages 577-586 , May 2010

Decision Analytic Model for Evaluation of Suspected Coronary Disease with Stress Testing and Coronary CT Angiography

  • Ethan J. Halpern, MD

      Affiliations

    • Department of Radiology, Thomas Jefferson University, 132 S 10th Street, Philadelphia, PA 19107-5244
    • Corresponding Author InformationAddress correspondence to: E.J.H.
    • ,
  • David Fischman, MD

      Affiliations

    • Division of Cardiology, Department of Medicine, Thomas Jefferson University, 132 S 10th Street, Philadelphia, PA 19107-5244
    • ,
  • Michael P. Savage, MD

      Affiliations

    • Division of Cardiology, Department of Medicine, Thomas Jefferson University, 132 S 10th Street, Philadelphia, PA 19107-5244
    • ,
  • Anish R. Koka, MD

      Affiliations

    • Division of Cardiology, Department of Medicine, Thomas Jefferson University, 132 S 10th Street, Philadelphia, PA 19107-5244
    • ,
  • Matthew DeCaro, MD

      Affiliations

    • Division of Cardiology, Department of Medicine, Thomas Jefferson University, 132 S 10th Street, Philadelphia, PA 19107-5244
    • ,
  • David C. Levin, MD

      Affiliations

    • Department of Radiology, Thomas Jefferson University, 132 S 10th Street, Philadelphia, PA 19107-5244

Received 9 November 2009 ,Accepted 15 December 2009.

References 

  1. Heron M, Hoyert DL, Murphy SL, Xu J, Kochanek KD, Tejada-Vera B. Deaths: final data for 2006. Natl Vital Stat Rep. 2009;57:1–135Available at: http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_14.pdf. Accessed January 20, 2010
  2. Lee TH, Boucher CA. Noninvasive tests in patients with stable coronary artery disease. N Engl J Med. 2001;344:1840–1845
  3. Vanhoenacker PK, Heijenbrok-Kal MH, Van Heste R, et al. Diagnostic performance of multidetector CT angiography for assessment of coronary artery disease: meta-analysis. Radiology. 2007;244:419–428
  4. Meijer AB, O Yl , Geleijns J, Kroft LJ. Meta-analysis of 40- and 64-MDCT angiography for assessing coronary artery stenosis. AJR Am J Roentgenol. 2008;191:1667–1675
  5. Hacker M, Jakobs T, Hack N, et al. Sixty-four slice spiral CT angiography does not predict the functional relevance of coronary artery stenoses in patients with stable angina. Eur J Nucl Med Mol Imaging. 2007;34:4–10
  6. Gaemperli O, Schepis T, Valenta I, et al. Functionally relevant coronary artery disease: comparison of 64-section CT angiography with myocardial perfusion SPECT. Radiology. 2008;248:414–423
  7. Schuijf JD, Bax JJ. CT angiography: an alternative to nuclear perfusion imaging?. Heart. 2008;94:255–257
  8. Budoff MJ, Rasouli ML, Shavelle DM, et al. Cardiac CT angiography (CTA) and nuclear myocardial perfusion imaging (MPI)—a comparison in detecting significant coronary artery disease. Acad Radiol. 2007;14:252–257
  9. Hendel RC, Patel MR, Kramer CM, et al. American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group; American College of Radiology; Society of Cardiovascular Computed Tomography; Society for Cardiovascular Magnetic Resonance; American Society of Nuclear Cardiology; North American Society for Cardiac Imaging; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology. J Am Coll Cardiol. 2006;48:1475–1497
  10. Gianrossi R, Detrano R, Mulvihill D, et al. Exercise-induced ST depression in the diagnosis of coronary artery disease. A meta-analysis. Circulation. 1989;80:87–98
  11. Garger AM, Solomon NA. Cost-effectiveness of alternative test strategies for the diagnosis of coronary artery disease. Ann Intern Med. 1999;130:719–728
  12. Budoff MJ, Dowe D, Jollis JG, et al. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol. 2008;52:1724–1732
  13. Meijboom WB, Meijs MF, Schuijf JD, et al. Diagnostic accuracy of 64-slice computed tomography coronary angiography. J Am Coll Cardiol. 2008;52:2135–2144
  14. Miller JM, Rochitte CE, Dewey M, et al. Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med. 2008;359:2324–2336
  15. Valentin J, Valentin DJ. Radiation dose to patients from radiopharmaceuticals: (addendum 2 to ICRP publication 53) approved by the commission in September 1997. Ann ICRP. 1998;28:1–123
  16. Mettler FA, Huda W, Yoshizumi TT, Mahesh M. Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology. 2008;248:254–263
  17. Hirai N, Horiguchi J, Fujioka C, et al. Prospective versus retrospective ECG-gated 64-detector coronary CT angiography: assessment of image quality, stenosis, and radiation dose. Radiology. 2008;248:424–430
  18. Shuman WP, Branch KR, May JM, et al. Prospective versus retrospective ECG gating for 64-detector CT of the coronary arteries: comparison of image quality and patient radiation dose. Radiology. 2008;248:431–437
  19. Raff GL, Chinnaiyan KM, Share DA, et al. Advanced Cardiovascular Imaging Consortium Co-Investigators. Radiation dose from cardiac computed tomography before and after implementation of radiation dose-reduction techniques. JAMA. 2009;301:2340–2348
  20. Coles DR, Smail MA, Negus IS, et al. Comparison of radiation doses from multislice computed tomography coronary angiography and conventional diagnostic angiography. J Am Coll Cardiol. 2006;47:1840–1845
  21. Gerber TC, Carr JJ, Arai AE, et al. Ionizing radiation in cardiac imaging: a science advisory from the American Heart Association Committee on Cardiac Imaging of the Council on Clinical Cardiology and Committee on Cardiovascular Imaging and Intervention of the Council on Cardiovascular Radiology and Intervention. Circulation. 2009;119:1056–1065
  22. Boston Scientific Corporation. Reimbursement. Available at: http://www.bostonscientific.com/Reimbursement. Accessed January 20, 2010.
  23. Diamond GA, Forrester JS. Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. N Engl J Med. 1979;300:1350–1358
  24. Heijenbrok-Kal MH, Fleischmann KE, Hunink MG. Stress echocardiography, stress single-photon-emission computed tomography and electron beam computed tomography for the assessment of coronary artery disease: a meta-analysis of diagnostic performance. Am Heart J. 2007;154:415–423
  25. Boden WE, O'Rourke RA, Teo KK, et al. COURAGE Trial Research Group Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356:1503–1516
  26. Shaw LJ, Berman DS, Maron DJ, et al. COURAGE Investigators. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: Results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation. 2008;117:1283–1291
  27. Weintraub WS, Spertus JA, Kolm P, et al. COURAGE Trial Research Group Effect of PCI on quality of life in patients with stable coronary disease. N Engl J Med. 2008;359:677–687

PII: S1076-6332(10)00011-5

doi: 10.1016/j.acra.2009.12.015

Academic Radiology
Volume 17, Issue 5 , Pages 577-586 , May 2010

Article Tools

* Image Usage & Resolution