Utility of multi-detector tomography angiography with equivocal exercise stress test in acute coronary syndrome

摘要

Dear Editor, We have read the article about the limited utility of exercise stress testing (EST) in evaluating the pre-diagnosis of acute coronary syndrome in subjects younger than 40 years old. We do not share the opinions of the authors about the utility of EST as we believe that cardiologists have a tendency to ignore the equivocal ST or T wave changes on the EST in the young and young adult patients with low probability of atherosclerotic coronary artery disease. Although Hamil-ton et al. reported that the EST had lower specificity and sensitivity, we reported that patients with new onset chest pain and equivocal EST had myocardial bridging and/or atherosclerotic plaque, especially on proximal or mid segments of coronary arteries.3 Of the 84 subjects, 12 subjects (16%, age 32.1 ± 9.8) (nine equivocal and three positive EST) were diagnosed as normal coronary anatomy using multi-slice computed tomography. Of 63 patients (84%) (50 equivocal and 13 positive EST), 19, 38 and six were diagnosed as coronary atherosclerosis (43.3 ± 7.3), myocar-dial bridging (34.1 ± 8.3) and coexisting coronary atherosclerosis and bridging (45.8 ±3.8), respectively. The mean age of those patients with only myocardial bridging complies with the study population and also have lower coronary risk profile. Additionally, we know that AMIs generally develop because of anatomically non-critical but vulnerable atherosclerotic coronary plaques.