Shamir Rai BSC, Abstract Co-Author: Nothing to Disclose

David Tso MD, Presenter: Nothing to Disclose

Patrick McLaughlin FFR(RCSI), Abstract Co-Author: Nothing to Disclose

Savvas Nicolaou MD, Abstract Co-Author: Nothing to Disclose

The purpose of our study was to retrospectively determine the incidence of acute myocardial infarction (MI) in emergency patients with suspected pulmonary embolism (PE) who underwent chest computed tomography pulmonary angiography (CTPE). Given the advent of low dose Triple-Rule-Out (TRO) CT examination with advanced detector and reconstruction technology, reduced contrast medium volumes and improved image quality at low tube kilovoltage, and the continued morbidity, mortality, costs, and catastrophic consequences associated with missed acute MIs it would seem feasible to perform TRO CT examinations over CT chest (CTPE) when looking for a suspected PE in the acute setting in high-risk patient populations.

The reports of 4596 consecutive patients who underwent CTPE between January 2011 and March 2014 at a single institution were retrospectively reviewed. The total number of patients that displayed CT signs of an acute MI were recorded and compared to the total number of CTPE that were conducted in the given time period.

Seventeen patients, of which 12 were male and 5 were female, ranging in age from 47 to 90, (mean age, 68.82 +/- 13.87 [SD] years) were identified as having an acute MI when being worked up for a PE via CTPE out of a total of 4596 chest CTs (PE protocol) conducted (0.37%). A total of 13 out of 17 patients (76%) were over the age of 60 with identified MI on the CTPE protocol.

This investigation establishes a baseline of 0.37% for the incidence of MI in patients being worked up for PE via chest CTPE protocol. Determination of the number of patients with aortic dissection, valvular, myocardial and other coronary artery disease (CAD) has not been explored in this study, but would further support a TRO CT over a chest CT (CTPE). As it stands TRO CT examination techniques, especially in patients over the age of 60, have the potential to reduce the number of hospitalized patients and reduce total health care costs.

Full TRO CT protocol should be considered over chest CT (CTPE) protocol for suspected acute PE in patients over the age of 60. This reduces the chances of missing significant findings such as a MI in a high-risk population.

Rai, S, Tso, D, McLaughlin, P, Nicolaou, S, Incidence of Acute Myocardial Infarction in Patients with Suspected Acute Pulmonary Embolism: Rationale for Low Dose Triple Rule out CT in the Acute Setting.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14017447.html