Abstract 2204: Coronary Multidetector Computed Tomography in the Assessment of Patients with Acute Chest Pain
Background: Noninvasive assessment of coronary atherosclerotic plaque and significant stenosis may improve early and accurate triage of patients presenting with acute chest pain to the emergency department (ED).
Methods: We conducted a blinded prospective study in patients presenting with acute chest pain to the ED between Mai and July 2005, who were admitted to the hospital to rule out acute coronary syndrome (ACS) with no ischemic ECG changes and negative initial biomarkers. Contrast-enhanced 64-slice MDCT coronary angiography was performed immediately before admission and data sets were evaluated for the presence of coronary atherosclerotic plaque and significant coronary artery stenosis. All providers were blinded to MDCT results. An expert panel determined the presence or absence of ACS during the index hospitalization and 5 month follow-up.
Results: Among 103 consecutive patients (40% female, mean age 54± 12 years), 14 patients had ACS. Both, the absence of significant coronary artery stenosis (73/103 patients) and coronary atherosclerotic plaque (41/103 patients) accurately predicted the absence of ACS (negative predictive values: 100%). In the subgroup of 62 patients with coronary atherosclerotic plaque the extent of CAD (number of segments with plaque) adjusted for age and sex but not the Goldman risk score predicted ACS (c statistic 0.61 and 0.88 respectively). The odds of having ACS increased by 60% (95% CI, 21 to 110%, P < .0002) with each additional segment with plaque.
Conclusions: Noninvasive assessment of CAD by MDCT may improve early and accurate triage of subjects presenting with acute chest pain to the ED.