Multislice cardiac computed tomography in symptomatic middle-aged women

Objective. To assess the accuracy of multislice cardiac computed tomography (MSCT) for detection of significant coronary artery disease (CAD) in middle-aged symptomatic women. Methods. We included 70 women (51 +/- 8 years) with complaints of chest pain or dyspnea, and an abnormal maximum exercise electrocardiogram (ECG) (8.6 +/- 1.4 metabolic equivalents). All had a MSCT using a 16 detector rows scanner, and coronary arteriography (CA). Blinded results of the two modalities were compared using a segment, vessel, and patient-based analysis. Results. On MSCT 36% had normal coronaries, 24% had significant CAD requiring revascularization, and the remainder had mild CAD. MSCT had reasonably high diagnostic accuracy at segment level (negative predictive value of 95%, positive predictive value 81%, specificity 99%, and sensitivity 50%), regarding single or multivessel CAD when both nonassessable and assessable segments were included in the analysis. The agreement between the segments comparing MSCT and CA for significant CAD was excellent at 98% (kappa value 0.89). Conclusions. In this cohort of middle-aged symptomatic women with an abnormal stress test, 24% had significant CAD requiring intervention. MSCT was highly accurate in diagnosing significant CAD with an excellent negative predictive value.