Abstract 2207: Non Invasive Assessment of Coronary Artery Disease by Multislice Computed Tomography in Patients With Acute Chest Pain: A prospective Study in 289 Patients
Coronary calcium scoring by multislice computed tomography allows the exclusion of coronary artery disease (CAD) with a high negative predictive value of up to 98 %. However diagnostic accuracy is limited by a reduced specificity of about 60 %. In this study we examined the possibility to improve the diagnostic accuracy by combining coronary calcium screening with non invasive coronary angiography (CTA) using 64 slice computed tomography in patients with acute chest pain. We examined 289 patients (122 female, 167 male, age 62.3 ± 11.4 years) in the emergency department with acute chest pain. We had excluded patients showing signs of acute myocardial ischemia in ECG or laboratory testing. First we determined the extent of coronary calcifications using the Sensation 64 scanner, Siemens Medical Solutions, Forchheim, Germany, and calculated the volume score. In patients with exclusion of coronary calcifications we refrained from an additional CTA. The exclusion of CAD was assumed. Also in patients with scores above 400 we refrained from an additional CTA as a limited evaluation because of extended calcifications had to be expected. These patients were assumed to suffer from CAD. In patients with scores from 1–400 we performed an additional CTA to assess possible coronary stenoses. Afterwards all patients underwent conventional coronary angiography (CA) as the gold standard. In 60 patients coronary calcifications could be excluded and CAD was ruled out in the subsequent CA. 78 patients of those 95 patients with scores above 400 (568 ± 249) showed significant CAD in CA. In the group of 134 patients with scores from 1– 400 who underwent CTA, 84 patients showed a significant CAD in CA. In 80 of these 84 patients also the CTA had revealed a significant CAD. In 48 of 50 patients without CAD in CA also CTA ruled out CAD. In 11 patients evaluation was not possible due to coronary calcifications, the results were considered as false negative resp. false positive. Over all we calculated a sensitivity of 98 % at a specificity of 85 %. A combined protocol using calcium scoring and CTA in patients with acute chest pain increases the reduced specificity of coronary screening alone in the assessment of CAD. At the same time non evaluable examinations due to coronary calcifications were reduced to 3 %.