Exercise testing and electron beam computed tomography in the evaluation of coronary artery disease

OBJECTIVES This study compared coronary artery calcium (CC) as detected by electron beam computed tomography (EBCT) with conventional stress testing i n the evaluation of patients with symptoms suggestive of coronary artery di sease (CAD). BACKGROUND Exercise electrocardiogram treadmill stress testing (treadmill-E CG) is limited by its requirement of a normal resting ECG and the ability o f the patient to exercise adequately. The addition of myocardial imaging ag ents such as technetium improves the sensitivity and specificity but substa ntially increases the cost and prolongs the testing time. The use of EBCT p rovides a noninvasive and rapid method for identifying the presence and amo unt of CC, which has been shown to be related to atherosclerosis, and may p rovide additional information in combination with more traditional noninvas ive testing methods. METHODS A total of 97 patients underwent technetium stress testing (technet ium-stress), treadmill-ECG, and EBCT coronary scanning within three months of coronary angiography for the evaluation of chest pain. RESULTS The relative risk (RR) of obstructive angiographic CAD for an abnor mal test was higher for EBCT (4.53) than either treadmill-EGG (1.72) or tec hnetium-stress (1.96). The low specificity of EBCT (470%) was improved by t he addition of treadmill-EGG (83%, p < 0.05). Electron beam computed tomogr aphy has a higher diagnostic ability than either treadmill-ECG or technetiu m-stress for the detection of obstructive angiographic CAD. CONCLUSION Electron beam computed tomography is an accurate and noninvasive alternative to traditional stress testing for the detection of obstructive CAD in symptomatic patients. (J Am Coil Cardiol 2000;36: 32-8) (C) 2000 by the American College of Cardiology.