Routine use of coronary computed tomography as initial diagnostic test for XXXX .

@entity1 @entity3979 @entity951 @entity6455 @entity453 @entity850
BACKGROUND: Coronary computed tomography (CCT) detects coronary obstruction with high sensitivity and might be useful for diagnosis of @entity951 . AIM: In this pilot study, we sought to prospectively evaluate the performance of CCT as initial work up and determine the significance of this strategy according to the pretest likelihood of having @entity453 ( @entity453 ). METHODS: One hundred and eighty @entity1 with chest discomfort and suspected angina were prospectively referred for CCT with a 64-slice CT scan. Invasive coronary angiography (ICA) was performed on the basis of CCT findings ( @entity850 >50%). @entity1 were classified into tertiles according to estimated pretest probability of obstructive @entity453 using the Duke Clinical Score (low, intermediate and high). Strategy failure was defined as unnecessary ICA or major adverse cardiac event (MACE) within 6 months in @entity1 without significant @entity850 by CCT. RESULTS: Pretest probability for @entity453 was 53    29%. Significant @entity850 was detected by CCT in 51 @entity1 ; 47 (26%) underwent ICA. Sixteen strategy failures were reported: 15 @entity1 (10%) were referred for @entity6455 that did not confirm significant @entity3979 and one MACE occurred in a @entity1 without significant @entity850 by CCT. Strategy failures were 8% in low-probability, 1.7% in intermediate-probability and 15% in high-probability @entity1 (P=0.03). CONCLUSIONS: CCT as an initial step for angina diagnosis is most effective in @entity1 with an intermediate probability of @entity453 . In @entity1 with low or high likelihood, it is associated with a high rate of unnecessary ICA but not with adverse events.
