Published online before print March 19, 2007, doi: 10.1161/CIRCULATIONAHA.106.618389
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2007;115:1762-1768.)
© 2007 American Heart Association, Inc.
Imaging |
Usefulness of 64-Slice Cardiac Computed Tomographic Angiography for Diagnosing Acute Coronary Syndromes and Predicting Clinical Outcome in Emergency Department Patients With Chest Pain of Uncertain Origin
From the Departments of Cardiovascular Medicine (R.R., D.A.H., B.S.L., R.J., B.K., M.Y.F.), Radiology (T.G., N.P.), and Emergency Medicine (A.K., R.S.), Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Correspondence to Basil S. Lewis, MD, FRCP, Louis Edelstein Professor of Medicine and Medical Research, Department of Cardiovascular Medicine, The Heart Hospital at Lady Davis Carmel Medical Center, 7 Michal St, Haifa 34362, Israel. E-mail lewis{at}tx.technion.ac.il
Received February 5, 2006; accepted January 26, 2007.
Background— Multidetector computed tomography (MDCT) has high diagnostic value for detecting or excluding coronary artery stenosis. We examined performance characteristics of MDCT for diagnosing or excluding an acute coronary syndrome in patients presenting to the emergency department (ED) with possible ischemic chest pain and examined relation to clinical outcome during a 15-month follow-up period.
Methods and Results— We prospectively studied 58 patients (56±10 years of age, 36% female) with chest pain possibly ischemic in origin and no new ECG changes or elevated biomarkers. The patients underwent 64-slice contrast-enhanced MDCT, which showed normal coronary vessels (no or trivial atheroma) in 15 patients, nonobstructive plaque in 20 (MDCT-negative patients), and obstructive coronary disease (
50% luminal narrowing) in 23 (MDCT-positive group). By further investigation (new elevation of cardiac biomarkers, abnormal myocardial perfusion scintigraphy and/or invasive angiography), acute coronary syndrome was diagnosed in 20 of the 23 MDCT-positive patients (ED MDCT sensitivity 100% [20/20], specificity 92% [35/38], positive predictive value 87% [20/23], negative predictive value 100% [35/35]). During a 15-month follow-up period, no deaths or myocardial infarctions occurred in the 35 patients discharged from the ED after initial triage and MDCT findings. One patient underwent late percutaneous coronary intervention (late major adverse cardiovascular events rate, 2.8%). Overall, ED MDCT sensitivity for predicting major adverse cardiovascular events (death, myocardial infarction, or revascularization) during hospitalization and follow-up was 92% (12/13), specificity was 76% (34/45), positive predictive value was 52% (12/23), and negative predictive value was 97% (34/35).
Conclusions— We found that 64-slice cardiac MDCT is a potentially valuable diagnostic tool in ED patients with chest pain of uncertain origin, providing early direct noninvasive visualization of coronary anatomy. ED MDCT had high positive predictive value for diagnosing acute coronary syndrome, whereas a negative MDCT study predicted a low rate of major adverse cardiovascular events and favorable outcome during follow-up.
CLINICAL PERSPECTIVE
Related Article:
-
Issue Highlights
Circulation 2007 115: 1697.[Extract] [Full Text]
This article has been cited by other articles:
 |
|
 |
|
  M. Kashiwagi, A. Tanaka, H. Kitabata, H. Tsujioka, H. Kataiwa, K. Komukai, T. Tanimoto, K. Takemoto, S. Takarada, T. Kubo, et al. Feasibility of Noninvasive Assessment of Thin-Cap Fibroatheroma by Multidetector Computed Tomography J. Am. Coll. Cardiol. Img., December 1, 2009; 2(12): 1412 - 1419. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Bastarrika, Y. S. Lee, W. Huda, B. Ruzsics, P. Costello, and U. J. Schoepf CT of Coronary Artery Disease Radiology, November 1, 2009; 253(2): 317 - 338. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Nagao, H. Matsuoka, H. Kawakami, H. Higashino, T. Mochizuki, M. Uemura, and S. Shigemi Myocardial Ischemia in Acute Coronary Syndrome: Assessment Using 64-MDCT Am. J. Roentgenol., October 1, 2009; 193(4): 1097 - 1106. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R Rubinshtein, T D Miller, E E Williamson, J Kirsch, R J Gibbons, A N Primak, C H McCollough, and P A Araoz Detection of myocardial infarction by dual-source coronary computed tomography angiography using quantitated myocardial scintigraphy as the reference standard Heart, September 1, 2009; 95(17): 1419 - 1422. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Bastarrika, C. Thilo, G. F. Headden, P. L. Zwerner, P. Costello, and U. J. Schoepf Cardiac CT in the Assessment of Acute Chest Pain in the Emergency Department Am. J. Roentgenol., August 1, 2009; 193(2): 397 - 409. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. J. Halpern Triple-Rule-Out CT Angiography for Evaluation of Acute Chest Pain and Possible Acute Coronary Syndrome Radiology, August 1, 2009; 252(2): 332 - 345. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. May, W. P. Shuman, J. N. Strote, K. R. Branch, L. M. Mitsumori, D. W. Lockhart, and J. H. Caldwell Low-Risk Patients With Chest Pain in the Emergency Department: Negative 64-MDCT Coronary Angiography May Reduce Length of Stay and Hospital Charges Am. J. Roentgenol., July 1, 2009; 193(1): 150 - 154. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. P. Shuman, K. R. Branch, J. M. May, L. M. Mitsumori, J. N. Strote, B. H. Warren, T. J. Dubinsky, D. W. Lockhart, and J. H. Caldwell Whole-Chest 64-MDCT of Emergency Department Patients with Nonspecific Chest Pain: Radiation Dose and Coronary Artery Image Quality with Prospective ECG Triggering Versus Retrospective ECG Gating Am. J. Roentgenol., June 1, 2009; 192(6): 1662 - 1667. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 U. Hoffmann, F. Bamberg, C. U. Chae, J. H. Nichols, I. S. Rogers, S. K. Seneviratne, Q. A. Truong, R. C. Cury, S. Abbara, M. D. Shapiro, et al. Coronary computed tomography angiography for early triage of patients with acute chest pain: the ROMICAT (Rule Out Myocardial Infarction using Computer Assisted Tomography) trial. J. Am. Coll. Cardiol., May 5, 2009; 53(18): 1642 - 1650. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Lentini, F. Monaco, F. Tancredi, M. Savasta, and R. Gaeta Aortic Valve Infective Endocarditis: Could Multi-Detector CT Scan Be Proposed for Routine Screening of Concomitant Coronary Artery Disease Before Surgery? Ann. Thorac. Surg., May 1, 2009; 87(5): 1585 - 1587. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 U. Hoffmann and F. Bamberg Is Computed Tomography Coronary Angiography the Most Accurate and Effective Noninvasive Imaging Tool to Evaluate Patients With Acute Chest Pain in the Emergency Department?: CT Coronary Angiography Is the Most Accurate and Effective Noninvasive Imaging Tool for Evaluating Patients Presenting With Chest Pain to the Emergency Department Circ Cardiovasc Imaging, May 1, 2009; 2(3): 251 - 263. [Full Text] [PDF]
|
|
|
|
|
|
R. C. Hendel Is Computed Tomography Coronary Angiography the Most Accurate and Effective Noninvasive Imaging Tool to Evaluate Patients With Acute Chest Pain in the Emergency Department?: CT Coronary Angiography Is the Most Accurate and Effective Noninvasive Imaging Tool for Evaluating Patients Presenting With Chest Pain to the Emergency Department: Antagonist Viewpoint Circ Cardiovasc Imaging, May 1, 2009; 2(3): 264 - 275. [Full Text] [PDF]
|
|
|
|
|
|
K. M. Takakuwa, E. J. Halpern, E. L. Gingold, D. C. Levin, and F. S. Shofer Radiation Dose in a "Triple Rule-Out" Coronary CT Angiography Protocol of Emergency Department Patients Using 64-MDCT: The Impact of ECG-Based Tube Current Modulation on Age, Sex, and Body Mass Index Am. J. Roentgenol., April 1, 2009; 192(4): 866 - 872. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Lentini, F. Tancredi, and R. Gaeta Preoperative coronary study in patients with acute aortic dissection and endocarditis. J. Thorac. Cardiovasc. Surg., March 1, 2009; 137(3): 788 - 789. [Full Text] [PDF]
|
|
|
|
|
|
B. Sundaram, S. Patel, N. Bogot, and E. A. Kazerooni Anatomy and Terminology for the Interpretation and Reporting of Cardiac MDCT: Part 1, Structured Report, Coronary Calcium Screening, and Coronary Artery Anatomy Am. J. Roentgenol., March 1, 2009; 192(3): 574 - 583. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. J. de Feyter, S. Achenbach, and K. Nieman CHAPTER 6 Cardiovascular Computed Tomography ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. C. Cury, K. Shash, J. T. Nagurney, G. Rosito, M. D. Shapiro, C. H. Nomura, S. Abbara, F. Bamberg, M. Ferencik, E. J. Schmidt, et al. Cardiac Magnetic Resonance With T2-Weighted Imaging Improves Detection of Patients With Acute Coronary Syndrome in the Emergency Department Circulation, August 19, 2008; 118(8): 837 - 844. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Ladapo, U. Hoffmann, F. Bamberg, J. T. Nagurney, D. M. Cutler, M. C. Weinstein, and G. S. Gazelle Cost-Effectiveness of Coronary MDCT in the Triage of Patients with Acute Chest Pain Am. J. Roentgenol., August 1, 2008; 191(2): 455 - 463. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. M. Takakuwa and E. J. Halpern Evaluation of a "Triple Rule-Out" Coronary CT Angiography Protocol: Use of 64-Section CT in Low-to-Moderate Risk Emergency Department Patients Suspected of Having Acute Coronary Syndrome Radiology, August 1, 2008; 248(2): 438 - 446. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. M. Henneman, J. D. Schuijf, G. Pundziute, J. M. van Werkhoven, E. E. van der Wall, J. W. Jukema, and J. J. Bax Noninvasive evaluation with multislice computed tomography in suspected acute coronary syndrome plaque morphology on multislice computed tomography versus coronary calcium score. J. Am. Coll. Cardiol., July 15, 2008; 52(3): 216 - 222. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W T Roberts, J J Bax, and L C Davies Cardiac CT and CT coronary angiography: technology and application Heart, June 1, 2008; 94(6): 781 - 792. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Schroeder, S. Achenbach, F. Bengel, C. Burgstahler, F. Cademartiri, P. de Feyter, R. George, P. Kaufmann, A. F. Kopp, J. Knuuti, et al. Cardiac computed tomography: indications, applications, limitations, and training requirements: Report of a Writing Group deployed by the Working Group Nuclear Cardiology and Cardiac CT of the European Society of Cardiology and the European Council of Nuclear Cardiology Eur. Heart J., February 2, 2008; 29(4): 531 - 556. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. K Seneviratne, F. Bamberg, and U. Hoffmann CT angiography: front line for acute coronary syndromes now? Heart, November 1, 2007; 93(11): 1325 - 1326. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Gaibazzi Letter by Gaibazzi Regarding Article, "Usefulness of 64-Slice Cardiac Computed Tomographic Angiography for Diagnosing Acute Coronary Syndromes and Predicting Clinical Outcome in Emergency Department Patients With Chest Pain of Uncertain Origin" Circulation, September 18, 2007; 116(12): e354 - e354. [Full Text] [PDF]
|
|
|
|
|
|
R. Rubinshtein, D. A. Halon, R. Jaffe, B. Karkabi, M. Y. Flugelman, B. S. Lewis, T. Gaspar, N. Peled, A. Kogan, and R. Shapira Response to Letter Regarding Article, "Usefulness of 64-Slice Cardiac Computed Tomographic Angiography for Diagnosing Acute Coronary Syndromes and Predicting Clinical Outcome in Emergency Department Patients With Chest Pain of Uncertain Origin" Circulation, September 18, 2007; 116(12): e355 - e355. [Full Text] [PDF]
|
|
|
|
|
|
T. C. Gerber, B. Kantor, and P. Chareonthaitawee Coronary computed tomographic angiography and exercise electrocardiography: a great match or unequal partners? Eur. Heart J., August 1, 2007; 28(15): 1787 - 1789. [Full Text] [PDF]
|
|
|
|
 |
|
 Can CT Angiography Predict Outcomes in Patients with Undifferentiated Chest Pain? Journal Watch Emergency Medicine, April 27, 2007; 2007(427): 2 - 2. [Full Text]
|
|