Multislice computed tomography coronary angiography in patients with stable and unstable angina: a multicenter study.

The study is a prospective multicenter non-randomized study. Three centers will be involved of which 2 centers are University Hospitals
1) Erasmus Medical Center and
2) Utrecht Medical Center and one affiliated teaching hospital: Antonius Ziekenhuis Nieuwegein.
The Erasmus MC will enroll 60 stable and 60 unstable patients while the other two participating center will enroll 50-60 stable and 50-60 unstable patients.

All patients will first undergo a non-invasive MS-CT coronary angiogram. The outcome of the MS-CT scan in terms of presence and location of significant coronary obstruction(s) will be separately assessed by 2 investigators (1 cardiologist, 1 radiologist) unaware of the outcome of the subsequent diagnostic angiogram. In case of disagreement consensus will be achieved by a third reader.

All patients, independent of the outcome of the scan, will be scheduled for diagnostic coronary angiography. The diagnostic coronary angiogram will be separately assessed by two cardiologists, unaware of the outcome of the MS-CT scan.
Quantification of coronary stenoses will be performed using automated contour detection algorithms (QCA).

Is diagnostic non-invasive coronary angiography with MS-CT a cost-effective alternative to diagnostic invasive coronary angiography in the management of patients with stable and unstable angina pectoris, referred for evaluation of the presence of significant coronary obstructions to determine further treatment strategies consisting of medical treatment, or revascularization (percutaneous coronary intervention or coronary bypass surgery).

N/A

MS-CT coronary angiography: An MS-CT coronary angiogram is performed using a bolus injection of 100 ml contrast agent into a brachial vein.
The scan is made during a breathhold of 20 seconds.
The whole procedure, including patient instruction, preparation and data acquisition requires about 10-15 minutes.
The scan is performed by a technician under supervision of a cardiologist or radiologist. Postprocessing and reading of the images requires another 10-20 minutes which is done off-line by a cardiologist and radiologist.

It is expected that faster post-processing tools will become available which will significantly reduce MS-CT reading time. A Siemens 16 slice MS-CT ( EMC, Rotterdam )and a Philips 16-slice MS-CT (UMC, Utrecht; Antonius Hospital Nieuwegein).