In the article by Amsterdam et al, “Testing of Low-Risk Patients Presenting to the Emergency Department With Chest Pain: A Scientific Statement From the American Heart Association,” which published ahead of print on July 26, 2010, and appears in the October 26, 2010, issue of the journal (Circulation. 2010;122;1756–1776), several corrections were needed.
1. On page 4, Table 1 has been replaced in its entirety. The original table appeared as:
2. On page 4, column 1, paragraph 2, line 5 reads “(PE) should be considered (Table 1).” It has been updated to read “(PE) should be considered (Table 2).”
3. On page 12, column 1, before the heading “Computed Tomography,” the heading “Coronary Artery Imaging,” the subheading “Coronary Calcium Score,” and a new paragraph were added. The heading “Computed Tomography Coronary Angiography” was changed to a subheading. The text before the “Computed Tomography Coronary Angiography” subheading now reads:
Coronary Artery Imaging
Coronary Calcium Score
Based on its close association with atherosclerosis, coronary artery calcification is considered a marker of CAD. It can be detected and quantified by either electron beam computed tomography or multidetector computed tomography. The coronary artery calcium (CAC) score is a quantitative index of the extent of calcification, has been used as an estimate of coronary plaque burden and confers independent risk. Population studies have demonstrated that a high CAC score is associated with increased risk for coronary events and, conversely, zero CAC indicates very low risk.129a In patients presenting to the ED with undifferentiated chest pain, a zero CAC score has been associated with a negative predictive value approaching 100% for early adverse events in studies of 100 to >1000 patients129b–129f; this prognostic value was maintained on follow-up of >4 years.129c Although the sensitivity of the CAC score for cardiac events is high, its positive predictive value is unsatisfactory and often entails additional evaluation. Further, not all coronary plaques contain calcium Calcification does not identify obstructive CAD, and increasing CAC is associated with advancing age and male sex.129a The emergence of CTCA has now redirected the focus of imaging in ED patients from risk stratification with CAC to direct visualization of coronary artery narrowing and plaque identification.
Computed Tomography Coronary Angiography”
4. On page 12, column 1, the last paragraph, the 11th line, new text has been added so that it now reads: Coronary Calcium Score “…value of 100% for ACS after 6 months of follow-up.134 A report of nearly 600 ED patients (TIMI risk score 0 to 2) likewise demonstrated a negative predictive value of 100% for adverse events within 30 days. However, the low prevalence of disease in this study limits its generalizability as only 7 patients in the cohort were found to have CAD; no patients had death or MI.134a Other smaller studies of CTCA…”
5. On page 12, column 2, the heading “Magnetic Resonance Imaging” has been changed to a subheading.
6. On page 20, in the References, references 129a through 129f and 134a were added.
These corrections have been made to the current online version of the article, which is available at http://circ.ahajournals.org/cgi/reprint/CIR.0b013e3181ec61df.
- © 2010 American Heart Association, Inc.