Kevin M. Takakuwa MD, Abstract Co-Author: Nothing to Disclose

Ethan Joseph Halpern MD, Presenter: Grant, Bristol-Myers Squibb Company Equipment support, Toshiba Corporation

To evaluate 64-slice MDCT for patients presenting to the chest pain center of an emergency department (ED) with symptoms suggestive of acute coronary syndrome (ACS).

ED patients with low to moderate risk for ACS (based upon a normal ECG, myoglobin and troponin I) were evaluated for aortic dissection, pulmonary embolism and coronary disease with CT. Examinations were performed with a 64 slice scanner (Brilliance Pro; Philips Medical Systems) during administration of 100cc of iodinated contrast material. Further stress testing was offered to patients with any evidence of coronary disease on CT. Patients were stratified based on TIMI risk scores. Structured data collection included demographics, laboratory test data, treatment provided, and 30-day outcomes.

Of 61 patients studied, TIMI risk scores were 0, 1, 2, 3, 4, and unknown in 21, 16, 13, 3, 2, and 6 patients respectively. Mean age was 50.2 +/- 10.3 years, with 30 males and 31 females. Non-coronary stenosis findings that could explain patient symptoms were found in 11 patients, including aortic dissection (n=1), pulmonary embolism (n=2), pneumonia (n=3), new cardiomyopathy (n=2), barretts esophagitis (n=1), hiatal hernia (n=1) and acute pancreatitis (n=1). Four studies were technically limited, but no coronary lesions >50% were seen. Of the remaining 46 patients, 2 had coronary lesions >70%, 3 had lesions between 50-70%, 12 had detectable lesions <50%, and 29 had completely normal coronaries. The majority of patients had no further testing after the CT scan. Follow-up testing before discharge included stress tests (n=17), echocardiography (n=2) and diagnostic cardiac catheterization (n=2). There were no adverse outcomes at 30 days.

Evaluation of low to moderate risk ACS patients with a “triple rule-out” CT scan allowed us to diagnose unsuspected non-coronary disease in 18% of patients, and to avoid additional diagnostic cardiac testing in a majority of patients with no adverse outcomes at 30 days.

Triple rule-out CT evaluation of low to moderate risk patients presenting with suspected acute coronary syndrome facilitates the diagnosis of non-coronary disease and can expedite the ED work-up.

Takakuwa, K, Halpern, E, "Triple Rule-out" MDCT for Low-to-Moderate Risk Emergency Department Patients Suspected of Having Acute Coronary Syndrome.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5014589.html