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Previous Volume 339:1964-1971 December 31, 1998 Number 27 Next

	Full Text PDF Editorial by Celermajer, D. S. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Reliable noninvasive assessment of coronary-artery stenoses and occlusions would constitute an advantage in the care of patients with known or suspected coronary artery disease. We investigated the accuracy of contrast-enhanced electron-beam computed tomography (CT) for the detection of high-grade coronary-artery stenoses and occlusions.

Methods Electron-beam CT was performed in 125 patients. After intravenous injection of a contrast agent, 40 cross-sectional images of the heart were acquired during inspiration, triggered by the electrocardiogram in diastole. Three-dimensional reconstructions of the heart and coronary arteries were rendered to facilitate evaluation of the images. The proximal and middle segments of the major coronary arteries were evaluated for the presence or absence of high-grade stenoses and occlusions. The results were compared with those of invasive coronary angiography in a blinded fashion.

Results Because of technical problems that impaired the quality of the images, 124 (25 percent) of the 500 coronary arteries studied (left main, left anterior descending, left circumflex, and right coronary) in a total of 125 patients were excluded from evaluation. No vessels could be evaluated in 19 patients (15 percent), and another 28 patients (22 percent) had one, two, or three vessels that could not be evaluated. In the remaining coronary arteries with adequate image quality, electron-beam CT permitted visualization of 69 of 75 high-grade stenoses and occlusions (sensitivity, 92 percent), whereas in 282 of 301 arteries, the absence of high-grade stenoses and occlusions was correctly detected (specificity, 94 percent).

Conclusions When image quality is adequate, electron-beam CT may be useful to detect or rule out high-grade coronary-artery stenoses and occlusions.

Source Information

From the Department of Internal Medicine II, University of Erlangen-Nürnberg, Erlangen, Germany.

Address reprint requests to Dr. Achenbach at the Medizinische Klinik II mit Poliklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Östliche Stadtmauerstr. 29, D-91054 Erlangen, Germany.

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N Engl J Med 1999; 340:1595-1596, May 20, 1999. Correspondence

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