Results of Computed Tomographic Coronary Angiography in Comparison with the Table of Pretest Probability of Chronic Coronary Syndrome

Abstract

Aim        To compare results of computed tomography coronary angiography (CTCA) with a table of pretest probability of chronic coronary syndrome (CCS) taking into account the following key variants: abnormality, microvascular damage, nonobstructive or obstructive atherosclerotic damage.Material and methods        50 patients (39 men, 20 women) aged 30 to 67 years were evaluated with a computed tomography scanner PHILIPS Brilliance iCT SP 128. A high pretest probability of ischemic heart disease was found in 44 % of cases and medium in 40%.Results   According to CCS data, coronary artery (CA) pathology was not found in 28 % of patients. CA hypoplasia was observed in 4 % of patients. 22 % of patients had muscular bridges narrowing the CA lumen during systole by 40-50%. In 26 % of cases, CA had minimal and early stenoses. Moderate and pronounced stenoses were observed in 20% of cases. In one case, there was a total occlusion of the circumflex branch. Calcinates were found in 9.1 % of patients with muscular bridges, in 61.5 % of patients with minimal and early stenoses, and in 80% of patients with moderate and pronounced stenoses. In the group with “clean” CA and congenital defects, calcinates were absent. The mean value of pretest probability was the highest in the patient group with moderate and pronounced stenoses, 22.5±13.13. It was significantly higher than in the group with muscular bridges (р=0.045) and congenital pathology of CA (р=0.01). At the same time, this value did not significantly differ from the group with “clean” CA and the group with minimal and early stenoses. Based on the study results, 2 bypass surgeries and 5 CA stentings were performed.Conclusion            Thus, the table of pretest probability of ischemic heart disease does not provide a differential diagnosis and evaluation of the nature of CA damage as compared to results of CTCA.