Triage of Patients with Suspected Coronary Artery Disease using Multislice Computed Tomography 1 Hans Hoffmann, MD, Hans-Peter Dübel, MD, Horst Laube, MD, Bernd Hamm, MD, Marc Dewey, MD Rationale and Objectives. Several studies have shown that multislice computed tomography (MSCT) has a high sensitiv- ity and specificity for detecting coronary artery stenoses. The aim of the present study was to investigate whether MSCT can reliably triage patients with suspected coronary artery disease (CAD) to coronary artery bypass grafting (CABG), per- cutaneous coronary intervention (PCI), or no revascularization. Materials and Methods. A total of 123 patients with suspected CAD who were referred for conventional coronary an- giography (CATH) additionally underwent MSCT (16*0.5 mm detector collimation). Therapeutic decisions made on the basis of CATH and MSCT strictly following current guidelines for treatment of CAD were compared with decisions made by a cardiac surgeon and an interventional cardiologist. Only MSCTs with at least adequate image quality in all coronary segments were included in the analysis (94/123). Results. Decisions made on the basis of MSCT and CATH according to guidelines did not differ significantly (agreement of 88%, 82 of 94, P = .319). The therapeutic decisions made by the interventional cardiologist and the cardiac surgeon based on CATH differed significantly (overall agreement of 79%, 74 of 94 cases, P  .001; cardiologist: 78% PCI and 22% CABG versus surgeon: 38% PCI and 62% CABG), whereas there was 100% agreement regarding decisions for or against invasive treatment. Conclusions. MSCT shows good agreement with CATH in triaging patients with suspected CAD to CABG, PCI, or no revascularization. The choice of revascularization procedure is significantly more strongly influenced by whether an inter- ventional cardiologist or a cardiac surgeon makes the decision than by the diagnostic test on which the decision is based. Key Words. Computed tomography; coronary artery imaging; revascularization; management; angiography. © AUR, 2007 Coronary artery disease (CAD) is one of the most com- mon diseases in industrialized countries (1). It is diag- nosed noninvasively using resting electrocardiography (ECG), exercise ECG, scintigraphy, echocardiography, and stress echocardiography. These diagnostic tests vary in their sensitivities and specificities (2). CAD is con- firmed or excluded invasively by conventional coronary angiography (CATH), which has a mortality of 0.11% and a complication rate of 1.7% for major adverse cardiac and cerebrovascular events (MACCE) when performed as an elective diagnostic procedure (3). Multislice computed tomography (MSCT) involves the same radiation expo- sure and reliably depicts the coronary vessels with a sen- sitivity and specificity for the detection of hemodynami- cally significant stenoses of 85% and 95%, respectively. The technical advances made in recent years have contin- uously improved image analysis (4,5). The aim of the present study was to determine how well a therapeutic decision for either coronary artery bypass grafting Acad Radiol 2007; 14:901–909 1 From the Departments of Radiology (H.H., B.H., M.D.) and Cardiology (H.-P.D.), Charité, Humboldt University Medical School, Berlin, Germany; De- partment of Medicine I (Cardiology, Angiology, and Pulmology), Klinikum Bran- denburg, Germany (H.H.); and Department of Cardiac Surgery, German Heart Center, Berlin, Germany (H.L.). Received April 2, 2007; accepted May 6, 2007. Address correspondence to: M.D. e-mail: marc.dewey@charite.de © AUR, 2007 doi:10.1016/j.acra.2007.05.005 901 Original Investigations