Coronary CT angiography outperforms calcium imaging in the triage of acute coronary syndrome

International Journal of Cardiology
Admir DedicKoen Nieman

Abstract

In this prospective study we determine the diagnostic value of coronary CT angiography (CTA) and calcium imaging in low to intermediate risk acute chest pain patients. One hundred and eleven consecutive patients (57 ± 11 years, 71 males) presenting to the emergency department with chest pain suggestive of acute coronary syndrome (ACS), but without indication for immediate catheter angiography, underwent both coronary CTA and calcium imaging without disclosure of the findings to the treating physicians. ACS was diagnosed in 19 patients (17%). Coronary calcium was present in 71 patients (64%). Coronary CTA identified 74 (67%) patients with coronary plaque and 36 (32%) patients with obstructive (≥ 50%) plaque. The sensitivity and specificity of the calcium scan were: 89% and 41%. The sensitivity and specificity of coronary CTA were: 100% and 40% based on the presence of any plaque and 89% and 79% based on the presence of >50% stenosis. C-statistics of the GRACE risk score (0.77 [95% CI 0.66-0.89]) improved after addition of coronary CTA (0.93 [0.88-0.98], p<0.01), though not after addition of calcium scores (0.81 [0.71-0.91], p=0.52). Follow-up at 3 months revealed four late revascularizations (no deaths or myocardial infarctions)...Continue Reading

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Citations

Feb 13, 2016·The British Journal of Radiology·Erica MaffeiFilippo Cademartiri
Jan 15, 2016·Journal of the American College of Cardiology·Admir DedicKoen Nieman
Apr 30, 2015·Emergency Medicine International·Yuwares SittichanbunchaKittisak Sawanyawisuth
Aug 1, 2015·Emergency Medicine Clinics of North America·Omoyemi Adebayo, Robert L Rogers
Jun 13, 2015·JACC. Cardiovascular Imaging·Koen Nieman, Adriaan Coenen
Feb 18, 2015·European Heart Journal·Koen Nieman, Udo Hoffmann
Jun 15, 2016·American Heart Journal·Martijn W SmuldersSebastiaan C A M Bekkers
Feb 18, 2016·Critical Pathways in Cardiology·Frank BreuckmannJochen Senges
Feb 11, 2021·Journal of Clinical Medicine·Alyssa L S ChowGary R Small
Nov 7, 2021·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Prayag MehtaDeborah Diercks

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