Abstract 4720: Additional Value of Myocardial Perfusion and Function over Coronary Stenosis for the Detection of Patients with Acute Coronary Syndrome by Cardiac CT
Objective: To determine the diagnostic accuracy of the assessment of myocardial perfusion deficits (MPD), regional wall motion abnormalities (RWMA), and coronary stenosis as detected by cardiac computed tomography (CT) for acute coronary syndrome (ACS) and whether combining this information provides incremental value.
Methods: We included a subset of patients enrolled in the ROMICAT study, an observational cohort study in patients with ACS and inconclusive initial ED evaluation, who underwent both 64-slice cardiac CT and invasive coronary angiography (ICA) (standard of care). CT data were analyzed for the presence of MPD and RWMA within the standard 17 myocardial segments blinded to the coronary anatomy by CT or ICA. Both CT and ICA data were assessed for the presence of significant stenosis (>50%). We determined the diagnostic accuracy and the area under the curve (AUC) of
MPD alone and RWMA alone;
Combined evaluation of MPD and RWMA; and
Combined evaluation of MPD, RWMA and stenosis for ACS.
Results: Among 35 patients (mean age 58 ±9 years, 69% male) who underwent both CT and ICA, 23/3531 (66%) had ACS (14 UA, 9 NSTEMI). The sensitivity and specificity of MPD alone and RWMA alone for ACS was 85% and 62% (AUC: 0.72) and 82% and 77% (AUC: 0.79); respectively. When combined, the diagnostic accuracy improved (sensitivity, specificity, and AUC: 86%, 84.6%, and 0.85; respectively) and was higher than the diagnostic accuracy for the presence of significant stenosis (sensitivity, specificity, and AUC: 73%, 85%, and 0.78; respectively). This approach was more sensitive in patients with stenosis >90% in ICA as compared to those with <90% stenosis (93% vs. 82%; respectively). In addition, this combined approach had 100% sensitivity in patients subsequently diagnosed with NSTEMI. An assessment including the presence of stenosis in CT in addition to MPD, and RWMA further improved the diagnostic accuracy (sensitivity, specificity, and AUC: 86%, 92%, and AUC: 0.89; respectively).
Conclusions: Comprehensive assessment of cardiac CT data sets for RWMA, MPD and coronary stenosis is incremental to the individual assessments alone and allows accurate diagnosis of ACS among those patients with acute chest pain currently undergoing ICA as part of standard care.