Percutaneous transluminal coronary angioplasty in dextrocardia: Case report

Percutaneous transluminal coronary angioplasty (PTCA) is described in a patient with dextrocardia. Selective cannulation of the right anterior descending coronary artery (morphologic left anterior descending coronary artery) was achieved with modification of standard guiding catheters “preformed” for the normal, levo-position heart. This report demonstrates the feasibility of PTCA in patients with cardiac malposition who survive into adulthood and develop coronary atherosclerosis.     

Relationships between coronary calcification detected at electron beam computed tomography and percutaneous transluminal coronary angioplasty results in coronary artery disease patients

Our objective was to assess the relationship between coronary artery calcification and outcomes of percutaneous transluminal coronary angioplasty (PTCA). Electron beam computed tomography (EBCT) was performed in 80 patients with coronary artery disease (CAD) who underwent PTCA. The calcium score in each coronary artery vessel was estimated (in Agatston units) and compared with the occurrence of complications and restenosis. Angioplasty had been performed in 96 coronary artery segments with stenosis in 80 patients. The average calcium score in the unsuccessful PTCA segments was significantly higher than in ones with successful results. For complications these values were 65.0±79.9 and 27.0±44.7, respectively (p=0.02), and for restenosis 63.9±87.9 and 27.3±41.3, respectively (p=0.03). Applying receiver operating characteristics analysis we determined sensitivity and specificity of EBCT for forecasting complications and restenosis. The best cut-off value of calcium score in segment of PTCA for prediction of restenosis was 27 (sensitivity 73%, specificity 67%), and for prediction of complications 29 (sensitivity 80%, specificity 74%). Coronary segments with extensive calcification were not optimal target lesions for PTCA. Analysis of coronary calcium score should be taken into consideration during planning of endovascular coronary interventions. Electronic Publication     

99Tcm-MIBI运动负荷-静息心肌灌注显像对冠心病患者经皮腔内冠状动脉血管成形术的疗效评价

Objective To evaluate the outcomes of stress-rest 99Tcm-MIBI peffusion imaging in patients with percutaneous transluminal coronary angioplasty (PTCA). Methods Twenty patients with coronary heart disease underwent repeated 99Tcm-MIBI stress-rest perfusion imaging before and after PICA, and semi-quantitative analysis, 8 cases of them repeated coronary angiography after 6 monthes. Results Twenty patients with total of 27 coronary artery stenosis were distended, the average vascular stenosis were (84.3±9.2)% before PTCA, and were reduced to(31.2±9.1)% after PTCA. Stress-rest perfusion imaging showed myocardial segments were reversible defect (myocardial ischemia) from 55 (30.6%) befor PTCA to 10 (5.6%) after PTCA, there were significant difference (X2=38.02, P<0.005). The improved rate was 81.8%, 8 patients underwent repeated stress-rest SPECT imaging after 6 monthes, 3 cases appears ischemia segment, and coronary angiography confirmed was restenosis. Conclusion 99Tcm-MIBI stress-rest perfusion imaging is a useful noninvasive method for evaluating the effect of PTCA and for restenosis.     

Prevalence and morphology of coronary artery ectasia with dual-source CT coronary angiography

To assess the prevalence and morphological characteristics of coronary artery ectasia (CAE) with CT coronary angiography (CTCA) in comparison to conventional catheterangiography (CCA). Dual-source CTCA examinations from 677 consecutive patients (223 women; median age 57 years) were retrospectively evaluated by two blinded observers for the presence of CAE defined as a diameter enlargement ≥1.5 times the diameter of adjacent normal coronary segments. Vessel diameters and contrast attenuation within and proximal to ectatic segments were measured. CCA was used to compare measurements obtained from CTCA with the coronary flow velocity by using the thrombolysis in myocardial infarction (TIMI) frame count. CTCA identified CAE in 20 of 677 (3%) patients. CCA was performed in ten of these patients. CAE diameter measurements with CTCA (10.0 ± 5.4 mm) correlated significantly (r = 0.92, p < 0.001) with the CCA measurements (8.8 ± 4.9 mm), but had higher diameters (levels of agreement: −1.0 to 3.4 mm). Contrast attenuation was significantly lower in the ectatic (343 ± 63 HU) than in the proximal (394 ± 60 HU) segments (p < 0.01). The attenuation difference significantly correlated with the CAE ratio (r = 0.67, p < 0.01) and the TIMI frame count (r = 0.58, p < 0.05). The prevalence of CAE in a population examined by CTCA is around 3%. Contrast attenuation measurements with CTCA correlate well with the flow alterations assessed with CCA.     

Usefulness of 40-slice multidetector row computed tomography to detect coronary disease in patients prior to cardiac valve surgery

Preoperative identification of significant coronary artery disease (CAD) in patients prior to valve surgery requires systematic invasive coronary angiography. The purpose of this current prospective study was to evaluate whether exclusion of CAD by multi-detector CT (MDCT) might potentially avoid systematic cardiac catheterization in these patients. Eighty-two patients (53 males, 62 ± 13 years) scheduled to undergo valve surgery underwent 40-slice MDCT before invasive quantitative coronary angiography (QCA). According to QCA, 15 patients had CAD (5 one-vessel, 6 two-vessel and 4 three-vessel disease). The remaining 67 patients had no CAD. On a per-vessel basis, MDCT correctly identified 27/29 (sensitivity 93%) vessels with and excluded 277/299 vessels (specificity 93%) without CAD. On a per-patient basis, MDCT correctly identified 14/15 patients with (sensitivity 93%) and 60/67 patients without CAD (specificity 90%). Positive and negative predictive values of MDCT were 67% and 98%. Performing invasive angiography only in patients with abnormal MDCT might have avoided QCA in 60/82 (73%). MDCT could be potentially useful in the preoperative evaluation of patients with valve disease. By selecting only those patients with coronary lesions to undergo invasive coronary angiography, it could avoid cardiac catheterization in a large number of patients without CAD. This work was supported by a grant of the Fondation Nationale de la Recherche Scientifique of the Belgian Government (FRSM 3.4557.02). Dr. Pouleur is supported by a personal grant of the Fondation Nationale de la Recherche Scientifique of the Belgian Government.     

Effects of percutaneous transluminal coronary angioplasty on cardiopulmonary responses during exercise

AIM: The aim of this study was to examine by means of percutaneous transluminal coronary angioplasty (PTCA) whether dilating blocked coronary arteries in patients with coronary heart disease will improve relevant attributes measured during cardiopulmonary exercise testing (CPET). METHODS: Fourteen myocardial ischemia patients (13 male, 1 female; age range: 42-72 years), who were referred for cardiac catheterization, participated in the study. Eight patients underwent PTCA (experimental group) and 6 did not (control group). All subjects performed CPET about 2 weeks before and 3 weeks after cardiac catheterization. RESULTS: The results of electrocardiogram (ECG) analysis reveal a very low predictive accuracy (36%) for identifying coronary heart disease and/or anatomical changes caused by the PTCA. However, selected CPET parameters in the experimental group only showed significant post-PTCA changes from baseline. Peak oxygen uptake (VO(2)) increased from 17.49 to 20.75 mL x kg(1) x min(1), ventilatory anaerobic threshold from 12.15 to 14.39 mL x kg(1) x min(1), peak oxygen pulse (O(2)pulse) from 11.76 to 13.27 mL x beat(1), and O(2)pulse slope from 7.05 to 9.25, slope category. No significant inter- or intra-group differences were found in peak exercise heart rate, respiratory exchange ratio, subjective rating of perceived exertion, or systolic and diastolic blood pressure. CONCLUSIONS: This study suggests that selected CPET parameters seem to be highly sensitive to changes in cardiac function caused by the PTCA, significantly more than with conventional stress ECG. These findings merit further investigation.     

Evaluation of patient-absorbed doses during coronary angiography and intervention by femoral and radial artery access

The aim of this study was to compare the radiation dose to patients during coronary angiography (CA) and coronary intervention (percutaneous transluminal coronary angioplasty, PTCA) by the femoral or radial artery access routes. A plane-parallel ionisation chamber, mounted on an under-couch X-ray tube (Siemens Coroskop TOP with an optional dose reduction system), recorded the dose-area product (DAP) to the patient from 40 coronary angiographies and 42 coronary interventions by the femoral route. The corresponding numbers for radial access were 36 and 24, respectively. Using a human-shaped phantom, conversion factors between maximum entrance surface dose and DAP were derived for CA and CA plus PTCA, respectively. The dose to the staff was measured with TL dosimeters for 22 examinations. Fluoroscopy time and DAP were significantly (p=0.003) larger using the radial access route for coronary angiography (7.5 min, 51 Gy cm²) than the corresponding values obtained from femoral access route (4.6 min, 38 Gy cm²). For CA plus PTCA the fluoroscopy time and DAP were larger for radial access (18.4 min, 75 Gy cm²) than for femoral access (12.5 min, 47 Gy cm²; p=0.013). In our experience, radial access did significantly prolong the fluoroscopy time and increase the patient doses.     

冠状动脉支架术后不同时间抗凝药物疗效研究

 目的观察急性冠状动脉综合征(Acute coronary syndrome,ACS)患者,行经皮腔内冠状动脉成形术(Percutaneoustransluminal coronary angioplasty,PTCA)及支架植入术后,使用不同抗血小板,抗凝药物不同时间对各种心脏事件发生的影响及不良反应.方法对320例患者植入520个支架,分别在3,6,9,12个月随访,观察术后联合应用抗凝、抗血小板药物不同时间对各种心脏事件发生的影响及不良反应.结果术后联合抗血小板,抗凝药物的使用可使各种心脏事件发生率减少,阿司匹林加波立维(硫酸氢氯吡格雷)12个月应用效果最佳(P＜0.05),各组不良反应无明显变化(P＞0.05).结论支架植入术后,使用阿司匹林、波立维,可明显减少心脏事件,药物不良反应无明显增加,建议长期12个月用药.法安明不宜长期使用,单用阿司匹林作用较联合应用效果差.     

经皮腔内冠状动脉成形术前后冠心病患者血清C反应蛋白及肌钙蛋白T的变化

 目的观测经皮腔内冠状动脉成形术(PTCA)对血清C反应蛋白(CRP)及肌钙蛋白T(TnT)的影响.方法我院进行PTCA的患者86例,同期进行冠状动脉造影(CAG)的患者90例.分别于PTCA和CAG当天及术后第2天清晨采集空腹血测定CRP及TnT值.结果PTCA组术后血清CRP水平显著高于术前(P＜0.01),而术后血清TnT水平与术前比较无显著变化(P＞0.05).CAG组造影后血清CRP及TnT水平与造影前比较均无显著性差别(P＞0.05).结论PTCA明显增加血清CRP浓度,可能与PTCA治疗后局部血管炎症有关,而非心肌坏死所致.     

Update on multidetector coronary CT angiography of coronary stents: in vitro evaluation of 29 different stent types with dual-source CT

The aim of this study was to test a large sample of the latest coronary artery stents using four image reconstruction approaches with respect to lumen visualization, lumen attenuation, and image noise in dual-source multidetector row CT (DSCT) in vitro and to provide a CT catalogue of currently used coronary artery stents. Twenty-nine different coronary artery stents (19 steel, 6 cobalt-chromium, 2 tantalum, 1 iron, 1 magnesium) were examined in a coronary artery phantom (vessel diameter 3 mm, intravascular attenuation 250 HU, extravascular density −70 HU). Stents were imaged in axial orientation with standard parameters: 32 × 0.6 collimation, pitch 0.24, 400 mAs, 120 kV, rotation time 0.33 s. Image reconstructions were obtained with four different convolution kernels (soft, medium-soft, standard high-resolution, stent-dedicated). To evaluate visualization characteristics of the stent, the lumen diameter, intraluminal density, and noise were measured. The stent-dedicated kernel offered best average lumen visualization (54 ± 8.3%) and most realistic lumen attenuation (222  ± 44 HU) at the expense of increased noise (23.9 ± 1.9 HU) compared with standard CTA protocols (p < 0.001 for all). The magnesium stent showed the least artifacts with a lumen visibility of 90%. The majority of stents (79%) exhibited a lumen visibility of 50–59%. Less than half of the stent lumen was visible in only six stents. Stent lumen visibility largely varies depending on the stent type. Magnesium is by far more favorable a stent material with regard to CT imaging when compared with the more common materials steel, cobalt-chromium, or tantalum. The magnesium stent exhibits a lumen visibility of 90%, whereas the majority of the other stents exhibit a lumen visibility of 50–59%. David Maintz and Matthias Burg contributed equally to this publication.     

Influence of intra-coronary enhancement on diagnostic accuracy with 64-slice CT coronary angiography

We assessed the effect of intra-coronary attenuation on diagnostic accuracy using 64-slice computed tomography coronary angiography (CT-CA). We enrolled 170 patients with suspected coronary artery disease who underwent conventional coronary angiography (CA) and 64-slice CT-CA (100 ml of Iomeprol 400 mg I/ml at 4 ml/s). The study population was divided into two groups (85 patients each based on median attenuation of 326 HU) based on mean arterial attenuation; group 1 with low attenuation and group 2 with high attenuation. Diagnostic accuracy for the detection of significant coronary artery stenosis was determined for both groups using CA as reference standard. Overall, 163 significant stenoses were detected in 1,030 assessable coronary artery segments in group 1 compared with 160 significant stenoses in 1,020 assessable segments in group 2. The average intra-coronary attenuation was significantly (P < 0.05) higher for group 2 (388 ± 46 HU) compared with group 1 (291 ± 33 HU). The corresponding sensitivity and specificity values for detection of significant coronary artery stenosis were higher for group 2 (96.3% and 97.6%, respectively) than for group 1 (82.8% and 93.2%, respectively) and were more marked in distal coronary segments than in proximal segments. Higher intra-coronary attenuation on CT-CA results in greater diagnostic accuracy for detection of coronary artery stenosis.     

Multislice computed tomography: angiographic emulation versus standard assessment for detection of coronary stenoses

The present study investigated angiographic emulation of multislice computed tomography (MSCT) (catheter-like visualization) as an alternative approach of analyzing and visualizing findings in comparison with standard assessment. Thirty patients (120 coronary arteries) were randomly selected from 90 prospectively investigated patients with suspected coronary artery disease who underwent MSCT (16-slice scanner, 0.5 mm collimation, 400 ms rotation time) prior to conventional coronary angiography for comparison of both approaches. Sensitivity and specificity of angiographic emulation [81% (26/32) and 93% (82/88)] were not significantly different from those of standard assessment [88% (28/32) and 99% (87/88)], while the per-case analysis time was significantly shorter for angiographic emulation than for standard assessment (3.4 ± 1.5 vs 7.0 ± 2.5 min, P < 0.001). Both interventional and referring cardiologists preferred angiographic emulation over standard curved multiplanar reformations of MSCT coronary angiography for illustration, mainly because of improved overall lucidity and depiction of sidebranches (P < 0.001). In conclusion, angiographic emulation of MSCT reduces analysis time, yields a diagnostic accuracy comparable to that of standard assessment, and is preferred by cardiologists for visualization of results.     

Accuracy of dual-source CT coronary angiography: first experience in a high pre-test probability population without heart rate control

The aim of this study was to assess the diagnostic accuracy of dual-source computed tomography (DSCT) for evaluation of coronary artery disease (CAD) in a population with extensive coronary calcifications without heart rate control. Thirty patients (24 male, 6 female, mean age 63.1±11.3 years) with a high pre-test probability of CAD underwent DSCT coronary angiography and invasive coronary angiography (ICA) within 14±9 days. No beta-blockers were administered prior to the scan. Two readers independently assessed image quality of all coronary segments with a diameter ≥1.5 mm using a four-point score (1: excellent to 4: not assessable) and qualitatively assessed significant stenoses as narrowing of the luminal diameter >50%. Causes of false-positive (FP) and false-negative (FN) ratings were assigned to calcifications or motion artifacts. ICA was considered the standard of reference. Mean body mass index was 28.3±3.9 kg/m² (range 22.4–36.3 kg/m²), mean heart rate during CT was 70.3±14.2 bpm (range 47–102 bpm), and mean Agatston score was 821±904 (range 0–3,110). Image quality was diagnostic (scores 1–3) in 98.6% (414/420) of segments (mean image quality score 1.68±0.75); six segments in three patients were considered not assessable (1.4%). DSCT correctly identified 54 of 56 significant coronary stenoses. Severe calcifications accounted for false ratings in nine segments (eight FP/one FN) and motion artifacts in two segments (one FP/one FN). Overall sensitivity, specificity, positive and negative predictive value for evaluating CAD were 96.4, 97.5, 85.7, and 99.4%, respectively. First experience indicates that DSCT coronary angiography provides high diagnostic accuracy for assessment of CAD in a high pre-test probability population with extensive coronary calcifications and without heart rate control.     

^99Tc^m-MIBI运动负荷-静息心肌灌注显像对冠心病患者经皮腔内冠状动脉血管成形术的疗效评价

目的 用^99Tc^m-甲氧基异丁基异腈（^99Tc^m-MIBI）运动-静息心肌灌注显像评价经皮腔内冠状动脉成形术（PTCA）的疗效。方法20例冠心病患者在PTCA术前和术后应用^99Tc^m-MIBI行运动负荷．静息心肌灌注显像,并对图像进行半定量分析。其中8例患者于术后6个月再次心肌灌注显像。结果对20例患者的27支冠状动脉呈狭窄病变进行PTCA,术前血管的平均狭窄为（84．3±9．2）％,术后平均残留狭窄减为（31．2±9．1）％。运动负荷-静息显像显示可逆性缺损（心肌缺血）的心肌节段数由术前的55个（30．6％）减为术后的10个（5．6％）,差异有显著性（x^2=38．02,P〈0．005）。术后心肌灌注的改善率为81．8％,8例患者术后6个月心肌显像显示3例出现缺血节段,冠状血管造影证实为再狭窄。结论^99Tc^m-MIBI运动负荷-静息心肌灌注显像是一种有效的无创性的判断PTCA术后疗效及再狭窄的方法。     

64排螺旋CT冠脉成像在冠心病诊断中的应用

目的 评价64排螺旋CT冠状动脉(冠脉)成像(CTA)在冠心病诊断中的应用价值.方法 以选择性冠脉造影(SCA)结果为金标准,采用64排螺旋CT对68例疑诊冠心病患者的冠脉主干及主要分支272节段进行重建和分析,评价其诊断冠心病的灵敏度和特异度.结果 CTA能够清晰显示冠脉主干及其分支狭窄、钙化、开口起源异常及桥血管病变,CTA发现钙化病变52节段,SCA仅发现钙化病变35节段.CTA诊断冠脉病变的灵敏度96.33%,特异度98.16%,阳性预测值97.22%,阴性预测值97.56%.其中对左主干、左前降支病变及＞75%的病变灵敏度最高,分别达到100%和94.4%.结论 CTA对冠脉狭窄病变、桥血管、开口畸形、支架管腔均显影良好,对冠心病诊断有较高的准确性,对钙化病变诊断率优于冠脉造影,可以作为冠心病高危人群无创性筛选检查及冠脉支架术后随访手段.     

Measurement of coronary calcium scores by electron beam computed tomography or exercise testing as initial diagnostic tool in low-risk patients with suspected coronary artery disease

We determined the efficiency of a screening protocol based on coronary calcium scores (CCS) compared with exercise testing in patients with suspected coronary artery disease (CAD), a normal ECG and troponin levels. Three-hundred-and-four patients were enrolled in a screening protocol including CCS by electron beam computed tomography (Agatston score), and exercise testing. Decision-making was based on CCS. When CCS≥400, coronary angiography (CAG) was recommended. When CCS<10, patients were discharged. Exercise tests were graded as positive, negative or nondiagnostic. The combined endpoint was defined as coronary event or obstructive CAD at CAG. During 12±4 months, CCS≥400, 10–399 and <10 were found in 42, 103 and 159 patients and the combined endpoint occurred in 24 (57%), 14 (14%) and 0 patients (0%), respectively. In 22 patients (7%), myocardial perfusion scintigraphy was performed instead of exercise testing due to the inability to perform an exercise test. A positive, nondiagnostic and negative exercise test result was found in 37, 76 and 191 patients, and the combined endpoint occurred in 11 (30%), 15 (20%) and 12 patients (6%), respectively. Receiver-operator characteristics analysis showed that the area under the curve of 0.89 (95% CI: 0.85–0.93) for CCS was superior to 0.69 (95% CI: 0.61–0.78) for exercise testing (P<0.0001). In conclusion, measurement of CCS is an appropriate initial screening test in a well-defined low-risk population with suspected CAD.     

Influence of convolution filtering on coronary plaque attenuation values: observations in an ex vivo model of multislice computed tomography coronary angiography

Attenuation variability (measured in Hounsfield Units, HU) of human coronary plaques using multislice computed tomography (MSCT) was evaluated in an ex vivo model with increasing convolution kernels. MSCT was performed in seven ex vivo left coronary arteries sunk into oil followingthe instillation of saline (1/∞) and a 1/50 solution of contrast material (400 mgI/ml iomeprol). Scan parameters were: slices/collimation, 16/0.75 mm; rotation time, 375 ms. Four convolution kernels were used: b30f-smooth, b36f-medium smooth, b46f-medium and b60f-sharp. An experienced radiologist scored for the presence of plaques and measured the attenuation in lumen, calcified and noncalcified plaques and the surrounding oil. The results were compared by the ANOVA test and correlated with Pearson’s test. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. The mean attenuation values were significantly different between the four filters (p < 0.0001) in each structure with both solutions. After clustering for the filter, all of the noncalcified plaque values (20.8 ± 39.1, 14.2 ± 35.8, 14.0 ± 32.0, 3.2 ± 32.4 HU with saline; 74.7 ± 66.6, 68.2 ± 63.3, 66.3 ± 66.5, 48.5 ± 60.0 HU in contrast solution) were significantly different, with the exception of the pair b36f–b46f, for which a moderate-high correlation was generally found. Improved SNRs and CNRs were achieved by b30f and b46f. The use of different convolution filters significantly modifief the attenuation values, while sharper filtering increased the calcified plaque attenuation and reduced the noncalcified plaque attenuation.     

Visualization of anomalous coronary arteries on dual-source computed tomography

The purpose of this study is to assess the capability of dual-source computed tomography (DSCT) in evaluating coronary artery anomalies. Early detection and evaluation of coronary artery anomalies is essential because of their potential association with myocardial ischemia and sudden death. In 16 patients (12 men, mean age 50 ± 14 years), anomalous coronary arteries were detected on contrast-enhanced DSCT in a patient cohort of 230 individuals (incidence of 7%). Six different types of anomalies were diagnosed (three fistula, four anomalies of the circumflex artery, four anomalous right coronary arteries, three anomalies of the left coronary artery, one absent left main coronary artery, and one left coronary artery arising from the pulmonary trunk). Of the 16 patients, 10 also underwent conventional coronary angiography (CAG). Retrospective evaluation of the CAGs by an experienced interventional cardiologist resulted in a precise diagnosis in 50% of patients. With DSCT, sufficient image quality and exact visualization of the aberrant anatomy were achieved in all patients. Therefore, DSCT seems to be an accurate diagnostic tool for examining the precise origin, course, and shape of aberrant coronary arteries.     

Coronary 64-slice CT angiography predicts outcome in patients with known or suspected coronary artery disease

The aim of this study was to assess the prognostic value of 64-slice CT angiography (CTA) in patients with known or suspected coronary artery disease (CAD). Sixty-four-slice coronary CTA was performed in 220 patients [mean age 63 ± 11 years, 77 (35%) female] with known or suspected CAD. CTA images were analyzed with regard to the presence and number of coronary lesions. Patients were followed-up for the occurrence of the following clinical endpoints: death, nonfatal myocardial infarction, unstable angina, and coronary revascularization. During a mean follow-up of 14 ± 4 months, 59 patients (27%) reached at least one of the predefined clinical endpoints. Patients with abnormal coronary arteries on CTA (i.e., presence of coronary plaques) had a 1st-year event rate of 34%, whereas in patients with normal coronary arteries no events occurred (event rate, 0%, p < 0.001). Similarly, obstructive lesions (≥50% luminal narrowing) on CTA were associated with a high first-year event rate (59%) compared to patients without stenoses (3%, p < 0.001). The presence of obstructive lesions was a significant independent predictor of an adverse cardiac outcome. Sixty-four-slice CTA predicts cardiac events in patients with known or suspected CAD. Conversely, patients with normal coronary arteries on CTA have an excellent mid-term prognosis.     

Detection of coronary artery calcifications predicting coronary heart disease: comparison of fluoroscopy and spiral CT

The aim of this study was to evaluate the clinical relevance of coronary artery calcifications detected by spiral CT, congruence with fluoroscopy (FS) and coronary angiography, and comparison with studies reporting on application of double-helical CT and ultrafast CT. Forty patients underwent spiral CT (2-mm slice thickness, table feed 3 mm/s), coronary angiography, and FS (performed in the usual manner). Stenosis and calcifications were evaluated semiquantitatively. Nineteen patients suffering from a stenosis ≥ 75 % were verified at coronary angiography. All had coronary artery calcification on spiral CT. Fluoroscopy did not detect 8 of 19 patients with a stenosis ≥ 75 % (1 vessel: n = 1; 2 vessels: n = 3; 3 vessels: n = 4). In spiral CT sensitivity was 100 % and specificity was 33 % (FS: 58 and 48 %). Positive predictive value was 83 % for spiral CT (FS: 50 %), and negative predictive value was 100 % (FS: 56 %). A significant linear increase in the calcification score was found for increasing maximal stenosis (p < 0.005). Spiral CT is more sensitive than FS in the recognition of hemodynamic relevant stenoses using the detection of coronary artery calcifications. Statistical parameters are comparable to ultrafast-CT. Spiral CT is a suitable non-invasive diagnostic technique in coronary heart disease. Coronary calcifications found incidentally in symptomatic patients at chest CT should be reported to the referring physician for further cardiological workup. Received 14 July 1997; Revision received 29 December 1997; Accepted 5 January 1998