EBCT BETTER THAN STRESS TEST

Exercise testing and Electron Beam Computed Tomography in the evaluation of coronary artery disease Shavelle DM, Budoff MJ, Lamont DH, Shavelle RM, Kennedy JM, Brundage BH,  Div. of Cardiology, St John’s Cardiovascular Research Ctr, Harbor-UCLA Med.Ctr, Torrance, USA. Journal of American College Cardiology 2000 Jul;36(1):32-8

INTRODUCTION: This study compared coronary artery calcium (CC) as detected by electron beam computed tomography (EBCT) with conventional stress testing in the evaluation of patients with symptoms suggestive of coronary artery disease (CAD). Exercise electrocardiogram treadmill stress testing (treadmill-ECG) is limited by its requirement of a normal resting ECG and the ability of the patient to exercise adequately. The addition of myocardial imaging agents such as technetium improves the sensitivity and specificity but substantially increases the cost and prolongs the testing time. The use of EBCT provides a noninvasive and rapid method for identifying the presence and amount of CC, which has been shown to be related to atherosclerosis, and may provide additional information in combination with more traditional noninvasive testing methods.

 METHODS: A total of 97 patients underwent technetium stress testing (technetium-stress), treadmill-ECG, and EBCT coronary scanning within three months of coronary angiography for the evaluation of chest pain.

  RESULTS:

Type of tests	Treadmill-ECG	Technetium stress	EBCT (CC)
Relative risk of angiographic obstruction  (for an abnormal test)	1.72	1.96	4.53

The low specificity of EBCT (47%) was improved by the addition of treadmill-ECG  (83%, p < 0.05).

CONCLUSIONS:   Electron beam computed tomography has a higher diagnostic ability than either treadmill-ECG or technetium-stress for the detection of obstructive angiographic CAD. Electron beam computed tomography is an accurate and noninvasive alternative to traditional stress testing for the detection of obstructive CAD in symptomatic patients.  

COMMENTS  by Dr Shavelle - EBCT has "higher diagnostic ability than either treadmill ECG or technetium-stress for the detection of obstructive angiographic coronary artery disease (CAD). EBCT is an accurate and noninvasive alternative to traditional stress testing for the detection of obstructive CAD in symptomatic patients." Also noted was that the combination of EBCT with simple exercise treadmill testing raised the accuracy of diagnosis resulting from the combined testing regimen significantly.