Charles S. White MD, Presenter: Nothing to Disclose

Thomas Flukinger, Abstract Co-Author: Research support, Riverain Medical

Dick Kuo, Abstract Co-Author: Nothing to Disclose

Eric Thorn MD, Abstract Co-Author: Nothing to Disclose

Jean Jeudy MD, Abstract Co-Author: Nothing to Disclose

Katrina M. Read MS, Abstract Co-Author: Employee, Koninklijke Philips Electronics NV

Our study attempts to determine the extent to which multidetector CT angiography (MDCTA) can predict the final diagnosis of acute coronary syndrome (ACS) in patients presenting to the emergency department with chest pain.

An IRB-approved prospective cohort study of subjects presenting to the ED with acute chest pain was undertaken from January 2006 through January 2007 at a single urban university tertiary referral center. CT scans were acquired with a 64-detector CT scanner (Phillips Medical Systems) with administration of iodinated contrast and retrospective ECG gating. For heart rates >70 beats per minute beta-blockers were administered. A triple rule-out protocol enabled assessment of non-cardiac causes of chest pain. Significant stenosis was defined as ≥50% (scenario 1) or ≥70% (scenario 2). All patients also underwent image-based stress testing. Image interpretation was agreed upon by two blinded cardiothoracic radiologists with the final diagnosis of each patient adjudicated by one cardiologist and one emergency physician.

One hundred subjects completed the protocol (50 M, 50 F). The mean age was 47 years (range 25-77). Myocardial perfusion imaging was obtained in 67, stress echocardiography in 24, and both studies in 9. For scenario 1 (≥50% stenosis), sensitivity was 100% and specificity was 91% for the final diagnosis of ACS. Positive and negative predictive values were 10% and 100%, respectively. Positive likelihood ratio was 11.1. For scenario 2 (≥70% stenosis), sensitivity was 100% and specificity was 98% for the final diagnosis of ACS. Positive and negative predictive values were 33.3% and 100%, respectively. Positive likelihood ratio was 50.

MDCTA demonstrates good sensitivity, specificity, and negative predictive value for the diagnosis of ACS.

MDCTA shows promise in expediting and improving ED triage of patients presenting with chest pain, potentially reducing the number of these patients who are hospitalized or discharged inappropriately.

White, C, Flukinger, T, Kuo, D, Thorn, E, Jeudy, J, Read, K, Chest Pain in the Emergency Department: Evaluation by 64-detector Cardiac CTA.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5006855.html