Shaista Meraj MBBS, MRCS, Presenter: Nothing to Disclose

Shahid Hussain MB, Abstract Co-Author: Nothing to Disclose

Heart of England NHS Foundation Trust is the first UK institution to offer Volume Cardiac CT (VCCT) scanning to chest pain admissions via the Accident and Emergency department. We present data from our trial of this novel chest pain management pathway.

Patients presenting via the emergency department with a strong clinical suspicion of coronary artery disease and meeting strict inclusion criteria (including -ve Troponin T, non evolving ECG changes and low/intermediate risk TIMI score) underwent a VCCT examination. Scans were optimised by intravenous B blockade and Sublingual GTN and a single beat volume acquisition scan was performed. All scans were reported by Consultant Cardiothoracic radiologists.

A total of 102 patients had VCCT performed. Lowest VCCT dose was 1.52mSv. 71% of scans demonstrated normal coronary arteries. But 15 patients within this group had an alternative significant pathology including PEs, aortic dissection, acute bronchiolitis and active sarcoidosis. 4% of patients in our low risk group underwent revascularization with angioplasty and stenting or coronary artery bypass graft surgery. The remaining patients were reassured and safely discharged with none re-presenting with chest pain in 6 months after the initial admission.

Volume cardiac CT scan (VCCT) as a direct access tool for Emergency chest pain admissions is a robust low dose test. Its high negative predictive value means that patients can be safely discharged with benefits of a safe, low dose diagnostic procedure. The test has the added advantage of identifying non-cardiac causes of chest pain and of identifying CAD which though not functionally significant can prompt lifestyle modification and secondary prevention measures.

First use of VCCT for chest pain admissions via the ER in UK. A robust test (+ details of scan technique) which is low dose and highly sensitive/specific for CAD -the leading cause of death in USA/UK.

Meraj, S, Hussain, S, Volume Cardiac CT: Revolutionizing the Management of Chest Pain Admissions via the ER.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11001129.html