Cheng Ting Lin MD, Presenter: Nothing to Disclose

Eric J. Feldmann MD, Abstract Co-Author: Nothing to Disclose

William Henry Moore MD, Abstract Co-Author: Research Grant, EDDA Technology, Inc Medical Board, EDDA Technology, Inc

Michael Poon MD, Abstract Co-Author: Speakers Bureau, Toshiba Corporation

To compare the severity of coronary artery disease (CAD) between initial and repeat CCTA in ER patients with recurrent acute chest pain.

An IRB-approved retrospective study was performed at a tertiary-care university medical center. From early 2007 to March 2012, the study population consisted of ER patients who underwent a CCTA for evaluation of acute chest pain and with a previous CCTA performed over one month ago at the same institution. Official interpretations rendered by cardiovascular attendings were available for review on PACS. For both the initial study and repeat exams, coronary artery calcium (CAC) scans were concurrently performed with CCTA as per protocol. Scans were performed on the 320-slice volume scanner or a 64 or less slice scanner. We classified the severity of CAD into 3 categories: normal coronaries, nonobstructive disease (<50% stenosis), and obstructive disease (>50% stenosis). Patient demographics and exam characteristics were also collected.

Initial and repeat CCTA exams for 61 patients were reviewed (mean age 49.5; 53% female). Median interval between exams was 377 days (range 41-1057 days). 72 (82%) of repeat studies versus 21 (24%) of initial studies were performed on the 320-slice scanner. 20 (23%) of patients had a increase of  greater than 20% in calcium score on repeat scan. On repeat exams, normal coronary arteries were observed in 43 (49%) cases, nonobstructive CAD in 37 (42%) cases, and obstructive disease in 8 (9%) cases. Repeat scan showed no change in disease severity for 77 (87%) patients. Worsening of severity category was seen in 11 (13%) cases. Of these, 5 patients were found to have new obstructive lesion and 3 of them went on to cardiac catheterization. In comparison, 1 of the 3 patients with obstructive lesions on both initial and repeat scans underwent cardiac catheterization. 

CCTA demonstrated stable CAD in most ER patients with recurrent acute chest pain, while a small number of remaining patients were found to have interval progression of disease. Therefore, our results suggest that repeat CCTA scans may be appropriately utilized to detect clinically significant progression of CAD in the emergent setting.

Emergency room (ER) patients presenting with recurrent acute chest pain who had a prior coronary CT angiogram (CCTA) may benefit from a repeat exam to assess for progression of coronary disease. 

Lin, C, Feldmann, E, Moore, W, Poon, M, Value of Repeat Coronary CT Angiography in Emergency Room Patients Presenting with Recurrent Acute Chest Pain.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12043692.html