Usefulness of noninvasive MSCT coronary angiography as first-line imaging technique in patients with chest pain: initial clinical experience B Stephen Schroeder a, * , Axel Kuettner b , Torsten Beck a , Andreas F. Kopp b , Christian Herdeg a , Martin Heuschmid b , Christof Burgstahler a , Ludger Seipel a , Claus D. Claussen b a Department of Internal Medicine, Division of Cardiology, Otfried-Mueller-Str. 10, 72076 Tuebingen, Germany b Department of Radiology, Division of Diagnostic Radiology, Eberhard-Karls-University Tuebingen, Germany Received 20 February 2004; accepted 5 May 2004 Available online 11 September 2004 Abstract Purpose: Comparative studies with invasive coronary angiography (ICA) indicated a good sensitivity and specificity in the noninvasive detection of coronary artery disease (CAD) using Multi-slice spiral computed tomography coronary angiography (MS-CTA). The aim was to investigate the usefulness of MS-CTA as first-line imaging technique in patients (pts) with known or suspected CAD and low to intermediate probability of a severe coronary lesion. We report on our initial clinical experience using MS-CTA without compelled ICA. Material and methods: One hundred thirty six patients with chest pain underwent MS-CTA on an outpatient basis (age 60F10, suspicion of CAD: n =95, suspicion of restenosis: n=24, after CABG: n=17). Based on the MS-CTA results, a recommendation concerning further diagnostics and therapy was given to each pt. A telephone interview was performed after 455F166 days to evaluate the further clinical course. Results: Per pt, 8.2F2.7 coronary segments could be evaluated. Based on the MSCT results, the presence of flow-limiting stenoses was excluded in n=77 (57%) pts (group I). An additional ICA was recommended in n =59 (43%) pts (group II). An ICA had been performed in meantime in 27/136 (20%) pts, and could be avoided in the majority of pts. Nevertheless, 58/136 (42%) pts reported on improved clinical symptoms and 42/136 (31%) pts of improved quality of life. Conclusions: MS-CTA was found to be useful to evaluate the need and to reduce the total number of ICA in pts with unclear chest pain. It appears to be the first noninvasive modality, which might be used on a clinical routine basis in selected groups of pts. D 2004 Elsevier Ireland Ltd. All rights reserved. Keywords: Multi-slice spiral computed tomography (MSCT); Coronary artery disease (CAD); Angina pectoris; Imaging; Coronary angiography 1. Background Coronary artery disease (CAD) is the leading cause of morbidity and mortality in the western world. Conventional invasive coronary angiography (ICA) is still the gold standard in the diagnosis of CAD. However, it is limited by its invasiveness and related possible complications. Mortality is quoted with 0.1% and the total risk of major complications with 1.7% [1]. The majority of all diagnostic ICA are not followed by therapeutic interventions; 611,882 diagnostic ICA were performed in 2001 in Germany alone, but coronary interventions in 195,280 only [2]. Thus for, there is a growing interest in noninvasive technologies to diagnose and visualize CAD [3]. Different noninvasive imaging techniques have been evaluated in the past few years. Especially, electron beam computed tomography (EBCT), magnetic resonance imag- ing (MRI), and multi-slice spiral computed tomography (MSCT) are currently under clinical investigation. 0167-5273/$ - see front matter D 2004 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2004.05.057 B This study was performed without additional financial support. * Corresponding author. Tel.: +0049 170 1644499; fax: +0049 7121 478962. E-mail address: Stephen.Schroeder@med.uni-tuebingen.de (S. Schroeder). International Journal of Cardiology 102 (2005) 469 – 475 www.elsevier.com/locate/ijcard