Document Detail


Usefulness of computed tomographic coronary angiography in patients with acute chest pain with and without high-risk features.
MedLine Citation:
PMID:  20691302     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The accuracy of 64-slice computed tomographic coronary angiography (CTA) and its ability to direct revascularization in patients with acute chest pain syndrome (ACPS) was investigated. A total of 107 patients with ACPS presenting to the emergency department and referred to cardiology were prospectively enrolled and underwent CTA. From the clinical features, the patients were categorized as having high-risk acute coronary syndrome features or no high-risk features. At the treating physician's discretion, the patients underwent risk stratification with either invasive coronary angiography (ICA) or technetium-99m single photon emission computed tomography. All tests were interpreted by experts unaware of the clinical information. All 52 patients with high-risk acute coronary syndrome features underwent ICA. Of the 55 patients with no high-risk features, 36 underwent single photon emission computed tomography and 19 underwent ICA. The patients were followed up until a decision regarding revascularization was made. Compared with ICA, the operating characteristics of CTA (per-patient analysis) were excellent, with a sensitivity of 98% (95% confidence interval [CI] 87% to 100%), specificity of 100% (95% CI 85% to 100%), positive predictive value of 100% (95% CI 90% to 100%), and negative predictive value of 97% (95% CI 80% to 100%). The agreement between CTA and routine testing (single photon emission computed tomography or ICA) was very good (kappa = 0.94). CTA correctly identified 40 patients (100%) who underwent revascularization and 61 (91.0%) who were treated medically (kappa = 0.88, 95% CI 0.79 to 0.97). In conclusion, CTA might represent a single modality that could be used to triage a wide spectrum of patients with ACPS and could have the potential to rule out coronary disease and identify those who might require revascularization.
Authors:
Benjamin J W Chow; Phil Joseph; Yeung Yam; Malek Kass; Li Chen; Rob S Beanlands; Terrence D Ruddy
Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of cardiology     Volume:  106     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-08-09     Completed Date:  2010-09-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  463-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. bchow@ottawaheart.ca
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome / radiography*
Acute Disease
Adult
Aged
Chest Pain / etiology,  radiography*
Coronary Angiography*
Female
Humans
Male
Middle Aged
Prospective Studies
Tomography, X-Ray Computed
Grant Support
ID/Acronym/Agency:
MSH-83718//Canadian Institutes of Health Research

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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