Author/Authors :
Hoffmann، نويسنده , , Udo and Bamberg، نويسنده , , Fabian and Chae، نويسنده , , Claudia U. and Nichols، نويسنده , , John H. and Rogers، نويسنده , , Ian S. and Seneviratne، نويسنده , , Sujith K. and Truong، نويسنده , , Quynh A. and Cury، نويسنده , , Ricardo C. and Abbara، نويسنده , , Suhny and Shapiro، نويسنده , , Michael D. and Moloo، نويسنده , , Jamaluddin and Butler، نويسنده , , Javed and Ferencik، نويسنده , , Maros and Lee، نويسنده , , Hang and Jang، نويسنده , , Ik-Kyung and Parry، نويسنده , , Blair A. and Brown، نويسنده , , David F. and Udelson، نويسنده , , James E. and Achenbach، نويسنده , , Stephan and Brady، نويسنده , , Thomas J. and Nagurney، نويسنده , , John T.، نويسنده ,
Abstract :
Objectives
tudy was designed to determine the usefulness of coronary computed tomography angiography (CTA) in patients with acute chest pain.
ound
of chest pain patients in the emergency department remains challenging.
s
d an observational cohort study in chest pain patients with normal initial troponin and nonischemic electrocardiogram. A 64-slice coronary CTA was performed before admission to detect coronary plaque and stenosis (>50% luminal narrowing). Results were not disclosed. End points were acute coronary syndrome (ACS) during index hospitalization and major adverse cardiac events during 6-month follow-up.
s
368 patients (mean age 53 ± 12 years, 61% men), 31 had ACS (8%). By coronary CTA, 50% of these patients were free of coronary artery disease (CAD), 31% had nonobstructive disease, and 19% had inconclusive or positive computed tomography for significant stenosis. Sensitivity and negative predictive value for ACS were 100% (n = 183 of 368; 95% confidence interval [CI]: 98% to 100%) and 100% (95% CI: 89% to 100%), respectively, with the absence of CAD and 77% (95% CI: 59% to 90%) and 98% (n = 300 of 368, 95% CI: 95% to 99%), respectively, with significant stenosis by coronary CTA. Specificity of presence of plaque and stenosis for ACS were 54% (95% CI: 49% to 60%) and 87% (95% CI: 83% to 90%), respectively. Only 1 ACS occurred in the absence of calcified plaque. Both the extent of coronary plaque and presence of stenosis predicted ACS independently and incrementally to Thrombolysis In Myocardial Infarction risk score (area under curve: 0.88, 0.82, vs. 0.63, respectively; all p < 0.0001).
sions
percent of patients with acute chest pain and low to intermediate likelihood of ACS were free of CAD by computed tomography and had no ACS. Given the large number of such patients, early coronary CTA may significantly improve patient management in the emergency department.
