Coronary CT angiography in acute chest pain (original) (raw)
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Coronary Computed Tomography Angiography in the Assessment of Acute Chest Pain in the Emergency Room
Arquivos Brasileiros de Cardiologia, 2013
The coronary computed tomography angiography has recently emerged as an accurate diagnostic tool in the evaluation of coronary artery disease, providing diagnostic and prognostic data that correlate directly with the data provided by invasive coronary angiography. The association of recent technological developments has allowed improved temporal resolution and better spatial coverage of the cardiac volume with significant reduction in radiation dose, and with the crucial need for more effective protocols of risk stratification of patients with chest pain in the emergency room, recent evaluation of the computed tomography coronary angiography has been performed in the setting of acute chest pain, as about two thirds of invasive coronary angiographies show no significantly obstructive coronary artery disease. In daily practice, without the use of more efficient technologies, such as coronary angiography by computed tomography, safe and efficient stratification of patients with acute chest pain remains a challenge to the medical team in the emergency room.
Coronary CT angiography for acute chest pain in the emergency department
Journal of Cardiovascular Computed Tomography, 2014
Coronary computed tomography angiography Cardiac Emergency department a b s t r a c t Acute chest pain in the emergency department (ED) is a common and costly public health challenge. The traditional strategy of evaluating acute chest pain by hospital or ED observation over a period of several hours, serial electrocardiography and cardiac biomarkers, and subsequent diagnostic testing such as physiologic stress testing is safe and effective. Yet this approach has been criticized for being time intensive and costly. This review evaluates the current medical evidence which has demonstrated the potential for coronary CT angiography (CTA) assessment of acute chest pain to safely reduce ED cost, time to discharge, and rate of hospital admission. These benefits must be weighed against the risk of ionizing radiation exposure and the influence of ED testing on rates of downstream coronary angiography and revascularization. Efforts at radiation minimization have quickly evolved, implementing technology such as prospective electrocardiographic gating and high pitch acquisition to significantly reduce radiation exposure over just a few years. CTA in the ED has demonstrated accuracy, safety, and the ability to reduce ED cost and crowding although its big-picture effect on total hospital and health care system cost extends far beyond the ED.
Acta bio-medica : Atenei Parmensis, 2010
To assess the predictive value of CT coronary angiography (CT-CA) in the stratification of patients with acute chest pain. We enrolled 48 patients (31 males and 17 females, mean age 61.0 +/- 14yrs) with acute chest pain of suspected coronary origin, without diagnostic alterations of the ECG and/or increase of the myocardial biomarkers. Sixty-four slice CT-CA was performed within 48-72 hours. Depending on the clinical judgment, the patients were dismissed or underwent conventional coronary angiography (CAG). Patients underwent clinical follow-up at 6 months, recording the prevalence of major cardiovascular events. One patient was excluded from the analysis because of poor image quality. CT-CA showed no coronary artery disease in 38.3% (18/47) of the patients, no significant coronary artery disease (<50% lumen reduction) in 31.9% (15/47) of the patients, significant coronary artery disease (> or = 50% lumen reduction) in 29.8% (14/47) of the patients. In 87.2% (41/47) of the pat...
Journal of Cardiovascular Computed Tomography, 2013
Use of coronary CT angiography (CTA) in the early evaluation of low-intermediate risk chest pain in the emergency department represents a common, appropriate application of CTA in the community. Three large randomized trials (CT-STAT, ACRIN-PA, and ROMICAT II) have compared a coronary CTA strategy with current standard of care evaluations in >3000 patients. These trials consistently show the safety of a negative coronary CT angiogram to identify patients for discharge from the emergency department with low rates of major adverse cardiovascular events, at significantly lower cost, and greater efficiency in terms of time to discharge. Together, these trials provide definitive evidence for the use of coronary CTA in the emergency department in patients with a low-tointermediate pretest probability of coronary artery disease. Clinical practice guidelines that recommend the use of coronary CTA in the emergency department are warranted.
The International Journal of Cardiovascular Imaging, 2011
The purpose of this study was to evaluate the performance of 320-row computed tomography angiography (CTA) in the identification of significant coronary artery disease (CAD) in patients presenting with acute chest pain and to examine the relation to outcome during follow-up. A total of 106 patients with acute chest pain underwent CTA to evaluate presence of CAD. Each CTA was classified as: normal, nonsignificant CAD (\50% luminal narrowing) and significant CAD (C50% luminal narrowing). CTA results were compared with quantitative coronary angiography. After discharge, the following cardiovascular events were recorded: cardiac death, non-fatal infarction, and unstable angina requiring revascularization. Among the 106 patients, 23 patients (22%) had a normal CTA, 19 patients (18%) had non-significant CAD on CTA, 59 patients (55%) had significant CAD on CTA, and 5 patients (5%) had non-diagnostic image quality. In total, 16 patients (15%) were immediately discharged after normal CTA and 90 patients (85%) underwent invasive coronary angiography. Sensitivity, specificity, and positive and negative predictive values to detect significant CAD on CTA were 100, 87, 93, and 100%, respectively. During mean follow-up of 13.7 months, no cardiovascular events occurred in patients with a normal CTA examination. In patients with non-significant CAD on CTA, no cardiac death or myocardial infarctions occurred and only 1 patient underwent revascularization due to unstable angina. In patients presenting with acute chest pain, an excellent clinical performance for the non-invasive assessment of significant CAD was demonstrated using CTA. Importantly, normal or non-significant CAD on CTA predicted a low rate of adverse cardiovascular events and favorable outcome during follow-up.
CT or Invasive Coronary Angiography in Stable Chest Pain
New England Journal of Medicine, 2022
BACKGROUND In the diagnosis of obstructive coronary artery disease (CAD), computed tomography (CT) is an accurate, noninvasive alternative to invasive coronary angiography (ICA). However, the comparative effectiveness of CT and ICA in the management of CAD to reduce the frequency of major adverse cardiovascular events is uncertain. METHODS We conducted a pragmatic, randomized trial comparing CT with ICA as initial diagnostic imaging strategies for guiding the treatment of patients with stable chest pain who had an intermediate pretest probability of obstructive CAD and were referred for ICA at one of 26 European centers. The primary outcome was major adverse cardiovascular events (cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke) over 3.5 years. Key secondary outcomes were procedurerelated complications and angina pectoris. RESULTS Among 3561 patients (56.2% of whom were women), follow-up was complete for 3523 (98.9%). Major adverse cardiovascular events occurred in 38 of 1808 patients (2.1%) in the CT group and in 52 of 1753 (3.0%) in the ICA group (hazard ratio, 0.70; 95% confidence interval [CI], 0.46 to 1.07; P = 0.10). Major procedure-related complications occurred in 9 patients (0.5%) in the CT group and in 33 (1.9%) in the ICA group (hazard ratio, 0.26; 95% CI, 0.13 to 0.55). Angina during the final 4 weeks of follow-up was reported in 8.8% of the patients in the CT group and in 7.5% of those in the ICA group (odds ratio, 1.17; 95% CI, 0.92 to 1.48). CONCLUSIONS Among patients referred for ICA because of stable chest pain and intermediate pretest probability of CAD, the risk of major adverse cardiovascular events was similar in the CT group and the ICA group. The frequency of major procedurerelated complications was lower with an initial CT strategy. (Funded by the European Union Seventh Framework Program and others; DISCHARGE ClinicalTrials .gov number, NCT02400229.
The American Journal of Cardiology, 2010
The accuracy of 64-slice computed tomographic coronary angiography (CTA) and its ability to direct revascularization in patients with acute chest pain syndrome (ACPS) was investigated. A total of 107 patients with ACPS presenting to the emergency department and referred to cardiology were prospectively enrolled and underwent CTA. From the clinical features, the patients were categorized as having high-risk acute coronary syndrome features or no high-risk features. At the treating physician's discretion, the patients underwent risk stratification with either invasive coronary angiography (ICA) or technetium-99m single photon emission computed tomography. All tests were interpreted by experts unaware of the clinical information. All 52 patients with high-risk acute coronary syndrome features underwent ICA. Of the 55 patients with no high-risk features, 36 underwent single photon emission computed tomography and 19 underwent ICA. The patients were followed up until a decision regarding revascularization was made. Compared with ICA, the operating characteristics of CTA (per-patient analysis) were excellent, with a sensitivity of 98% (95% confidence interval [CI] 87% to 100%), specificity of 100% (95% CI 85% to 100%), positive predictive value of 100% (95% CI 90% to 100%), and negative predictive value of 97% (95% CI 80% to 100%). The agreement between CTA and routine testing (single photon emission computed tomography or ICA) was very good (؍ 0.94). CTA correctly identified 40 patients (100%) who underwent revascularization and 61 (91.0%) who were treated medically (؍ 0.88, 95% CI 0.79 to 0.97). In conclusion, CTA might represent a single modality that could be used to triage a wide spectrum of patients with ACPS and could have the potential to rule out coronary disease and identify those who might require revascularization.