Multislice computed tomography coronary angiography in patients admitted with a suspected acute coronary syndrome |
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Authors: | Duncan R Coles Peter Wilde Martin Oberhoff Chris A Rogers Karl R Karsch Andreas Baumbach |
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Institution: | (1) Department of Cardiology, Bristol Royal Infirmary, Bristol, BS2 8HW, UK;(2) Department of Clinical Radiology, Bristol Heart Institute, Bristol Royal Infirmary, Bristol, UK |
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Abstract: | Objectives The aim of this prospective clinical study was to assess the accuracy and clinical relevance of multislice computed tomography
coronary angiography (MSCTCA) in patients presenting with acute chest pain.
Background Multislice computed tomography coronary angiography has shown ability to detect accurately coronary artery disease (CAD) in
selected elective patient groups.
Methods One hundred and twenty patients presenting with acute chest pain (<24 h) underwent MSCTCA (Siemens Sensation 16) before a
scheduled inpatient conventional coronary angiogram (CCA). Exclusion criteria included patients with STEMI, non-sinus rhythm,
contraindication to β blockers and renal impairment. Blinded visual assessment of MSCTCA to detect CAD was performed on an
11-segment model. The accuracy of MSCTCA was compared to CCA to detect significant stenoses (≥50%).
Results One hundred and thirteen patients underwent both investigations. The prevalence of significant CAD was 74%. 1,243 native segments
were assessed by MSCTCA. The overall ability of MSCTCA to detect the presence of ≥1 significant stenosis in all native segments
had a sensitivity of 92% (95%CI 83–97%), specificity of 55% (95%CI 35–74%), positive predictive value of 86% (95%CI 76–93%)
and negative predictive value of 70% (95%CI 47–87%). 22% of all segments (mostly distal) were non-analyzable. Coronary calcification
was a major cause of false positivity.
Conclusion In a prospective study of unselected patients presenting with acute chest pain, the diagnostic accuracy of 16-slice CT coronary
angiography was moderate and less than reported from studies in elective patients. The clinical relevance of this technology
to screen patients with acute chest pain is limited.
Condensed Abstract Multislice CT coronary angiography (MSCTCA) and conventional coronary angiography (CCA) were used to assess 120 patients presenting
with acute chest pain. MSCTCA was compared to CCA to detect significant stenoses (≥50%). In 113 directly comparable patients
MSCTCA had a sensitivity of 92% (95%CI 83–97%) and specificity of 55% (95%CI 35–74%) to detect the presence of ≥1 significant
stenosis in all native segments. In this patient cohort with a high prevalence of coronary disease and coronary calcification,
the accuracy and clinical relevance of 16 slice MSCTCA to screen and risk stratify patients with acute chest pain is limited.
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Keywords: | Chest pain Coronary angiography Coronary disease Diagnostic imaging Tomography spiral computed |
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