and chronic kidney disease were 46%, 43% and 13% respectively, and 14 (8%) patients had previous coronary artery bypass surgery. Exercise SE was performed in 84 (46%) patients and Dobutamine SE in 100 (54%) patients. Contrast was used in 158 patients (86%). In 108 patients (59%), the SE was positive for inducible ischaemia. From 217 vessels analysed, the Left Anterior Descending Artery, Right Coronary Artery, Left Circumflex Artery and Left Main Coronary artery were involved in 120 (55%), 47 (22%), 30 (14%), 18 (8%) respectively, with 2 vessels being grafts. 46 FFR measurements were positive (21%) and 171 were negative (79%), using a cut off of£ 0.80. At the vessel level, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of SE for identifying significant disease as assessed by FFR was 70%, 77%, 45% and 90% respectively. In 73 patients, there was single vessel disease on angiography. At the vessel level, the sensitivity, specificity, PPV and NPV were 85%, 68%, 37% and 95%. Conclusion To date this is the largest study comparing SE and FFR for the assessment of the physiological significance of a coronary lesion, and reflects real world experience. SE demonstrates good diagnostic accuracy and excellent NPV for excluding flow-limiting disease. The low PPV is likely to represent the commencement of medical therapy following a positive SE, as well as referral bias (since only patients with positive SE underwent angiography) as well as the low prevalence of positive FFR measurements in this population. The presence of a haemodynamically significant stenosis can be accurately ruled out with SE. Background NICE guidelines recommend CT coronary angiography (CTCA) as a first line investigation for patients with chest pain and an estimated likelihood of coronary artery disease (CAD) of 10-29%. These guidelines do not recommend exercise testing in this patient group. The recently published PROMISE and SCOT-HEART studies extended the use of CTCA to moderate and high risk patients. Neither study has shown clear clinical benefit for patient randomised to CTCA and there remains a divergence of opinion regarding the appropriateness of CTCA in these patient groups. In particular, there is a concern that CTCA may increase the number of future invasive coronary angiograms. We studied patients referred to the CTCA service in our centre and compared their predicted risk, prior stress testing and subsequent investigations to the NICE guidance and with data from the PROM-ISE and SCOT-Heart studies. Methods Data was collected prospectively for consecutive patients undergoing CTCA over a 3 month period. CTCA reports were retrospectively reviewed with details recorded of the scan protocol, scan quality and severity of coronary disease. Our cardiac catheterisation database was retrospectively ALTHOUGH CT CORONARY ANGIOGRAPHY IN THE WEST OF SCOTLAND IS USED IN A HIGHER RISK POPULATION THAN RECOMMENDED BY NICE, THE RATE OF SUBSEQUENT INVASIVE CORONARY ANGIOGRAPHY IS LOWER THAN IN THE PROMISE AND...
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