Comparison of Exercise Treadmill Testing With Cardiac CT Angiography Among Patients Presenting To The Emergency Room With Chest Pain: ROMICAT Study.
Circ Cardiovasc Imaging. 2012 Feb 3;
Authors: Blankstein R, Ahmed W, Bamberg F, Rogers IS, Schlett CL, Nasir K, Fontes J, Tawakol A, Brady TJ, Nagurney JT, Hoffmann U, Truong QA
Abstract
BACKGROUND: -The aim of our study was to (a) examine how data from exercise treadmill testing (ETT) can identify patients who have coronary plaque or stenosis, using CT angiography (CTA) as the reference standard, (b) identify patient characteristics that may be used in selecting ETT versus CTA. METHODS AND RESULTS: -The Rule Out Myocardial Infarction Using Computer Assisted Tomography (ROMICAT) trial was an observational cohort study of acute chest pain patients presenting to the emergency department with normal initial troponin and a non-ischemic electrocardiogram. Univariate and multivariable analysis were performed to assess the relationship of baseline clinical data and ETT parameters with coronary plaque and stenosis on CTA. Out of the 220 patients who had ETT (mean age 51, 63% male), 21 (10%) had positive results. A positive ETT had a sensitivity of 30% and specificity of 93% to detect >50% stenosis. The sensitivity increased to 83% after excluding uninterpretable segments and evaluating the ability to detect a >70% stenosis. Predictors of plaque included older age, male gender, diabetes, hypertension, hyperlipidemia, lower functional capacity, and a lower Duke treadmill score. Both a positive ETT and a low Duke treadmill score were significant univariate and multivariable predictors of stenosis >50% on CTA While the prevalence of stenosis by CTA was greater among patients with more risk factors, coronary stenosis was not present among men <40 or women <50 years old or individuals who achieved at least 13 METS on ETT. CONCLUSIONS: -Among low to intermediate risk patients with acute chest pain, a positive ETT has a limited sensitivity but high specificity for the detection of >50% stenosis by CTA. While patients with a high number of clinical risk factors are more likely to have obstructive CAD, those who are young or who would be expected to have a very high exercise capacity are unlikely to have coronary stenosis and, therefore, may benefit from initial ETT testing instead of CTA.
PMID: 22308274 [PubMed - as supplied by publisher]