Automated Computer-Assisted Diagnosis of Obstructive Coronary Artery Disease in Emergency Department Patients Undergoing 256-Slice Coronary Computed Tomography Angiography for Acute Chest Pain

2015 ◽  
Vol 116 (7) ◽  
pp. 1017-1021 ◽  
Author(s):  
Sharbell Hashoul ◽  
Tamar Gaspar ◽  
David A. Halon ◽  
Basil S. Lewis ◽  
Yuval Shenkar ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Emergency Department ◽  
Coronary Computed Tomography Angiography ◽  
Obstructive Coronary Artery Disease ◽  
Acute Chest Pain ◽  
Computer Assisted ◽  
Artery Disease ◽  
Assisted Diagnosis ◽  
Emergency Department Patients

scholarly journals Clinical risk factors and atherosclerotic plaque extent to define risk for major events in patients without obstructive coronary artery disease: the long-term coronary computed tomography angiography CONFIRM registry

2020 ◽  
Vol 21 (5) ◽  
pp. 479-488 ◽  
Author(s):  
Alexander R van Rosendael ◽  
A Maxim Bax ◽  
Jeff M Smit ◽  
Inge J van den Hoogen ◽  
Xiaoyue Ma ◽  
...  
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Computed Tomography Angiography ◽  
Prognostic Value ◽  
Coronary Computed Tomography Angiography ◽  
Obstructive Coronary Artery Disease ◽  
Artery Disease

Abstract Aims In patients without obstructive coronary artery disease (CAD), we examined the prognostic value of risk factors and atherosclerotic extent. Methods and results Patients from the long-term CONFIRM registry without prior CAD and without obstructive (≥50%) stenosis were included. Within the groups of normal coronary computed tomography angiography (CCTA) (N = 1849) and non-obstructive CAD (N = 1698), the prognostic value of traditional clinical risk factors and atherosclerotic extent (segment involvement score, SIS) was assessed with Cox models. Major adverse cardiac events (MACE) were defined as all-cause mortality, non-fatal myocardial infarction, or late revascularization. In total, 3547 patients were included (age 57.9 ± 12.1 years, 57.8% male), experiencing 460 MACE during 5.4 years of follow-up. Age, body mass index, hypertension, and diabetes were the clinical variables associated with increased MACE risk, but the magnitude of risk was higher for CCTA defined atherosclerotic extent; adjusted hazard ratio (HR) for SIS >5 was 3.4 (95% confidence interval [CI] 2.3–4.9) while HR for diabetes and hypertension were 1.7 (95% CI 1.3–2.2) and 1.4 (95% CI 1.1–1.7), respectively. Exclusion of revascularization as endpoint did not modify the results. In normal CCTA, presence of ≥1 traditional risk factors did not worsen prognosis (log-rank P = 0.248), while it did in non-obstructive CAD (log-rank P = 0.025). Adjusted for SIS, hypertension and diabetes predicted MACE risk in non-obstructive CAD, while diabetes did not increase risk in absence of CAD (P-interaction = 0.004). Conclusion Among patients without obstructive CAD, the extent of CAD provides more prognostic information for MACE than traditional cardiovascular risk factors. An interaction was observed between risk factors and CAD burden, suggesting synergistic effects of both.

Computed tomography angiography and other applications of computed tomography

2016 ◽  
Author(s):  
Michiel A de Graaf ◽  
Arthur JHA Scholte ◽  
Lucia Kroft ◽  
Jeroen J Bax
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Computed Tomography Angiography ◽  
Coronary Computed Tomography Angiography ◽  
Acute Chest Pain ◽  
Coronary Computed Tomography ◽  
Non Invasive ◽  
Artery Disease

Patients presenting with acute chest pain constitute a common and important diagnostic challenge. This has increased interest in using computed tomography for non-invasive visualization of coronary artery disease in patients presenting with acute chest pain to the emergency department; particularly the subset of patients who are suspected of having an acute coronary syndrome, but without typical electrocardiographic changes and with normal troponin levels at presentation. As a result of rapid developments in coronary computed tomography angiography technology, high diagnostic accuracies for excluding coronary artery disease can be obtained. It has been shown that these patients can be discharged safely. The accuracy for detecting a significant coronary artery stenosis is also high, but the presence of coronary artery atherosclerosis or stenosis does not imply necessarily that the cause of the chest pain is related to coronary artery disease. Moreover, the non-invasive detection of coronary artery disease by computed tomography has been shown to be related with an increased use of subsequent invasive coronary angiography and revascularization, and further studies are needed to define which patients benefit from invasive evaluation following coronary computed tomography angiography. Conversely, the implementation of coronary computed tomography angiography can significantly reduce the length of hospital stay, with a significant cost reduction. Additionally, computed tomography is an excellent modality in patients whose symptoms suggest other causes of acute chest pain such as aortic aneurysm, aortic dissection, or pulmonary embolism. Furthermore, the acquisition of the coronary arteries, thoracic aorta, and pulmonary arteries in a single computed tomography examination is feasible, allowing ‘triple rule-out’ (exclusion of aortic dissection, pulmonary embolism, and coronary artery disease). Finally, other applications, such as the evaluation of coronary artery plaque composition, myocardial function and perfusion, or fractional flow reserve, are currently being developed and may also become valuable in the setting of acute chest pain in the future.

scholarly journals Occult obstructive coronary artery disease is associated with prolonged cardiac troponin elevation following strenuous exercise

2019 ◽  
Vol 27 (11) ◽  
pp. 1212-1221 ◽  
Author(s):  
Øyunn Kleiven ◽  
Torbjørn Omland ◽  
Øyvind Skadberg ◽  
Tor H Melberg ◽  
Magnus F Bjørkavoll-Bergseth ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Computed Tomography Angiography ◽  
Cardiac Troponin ◽  
Coronary Computed Tomography Angiography ◽  
Obstructive Coronary Artery Disease ◽  
Strenuous Exercise ◽  
Coronary Computed Tomography ◽  
Artery Disease

Background Sudden cardiac death among middle-aged recreational athletes is predominantly due to myocardial ischaemia. This study examined whether measuring cardiac troponin I and T (cTnI and cTnT) after strenuous exercise could identify occult obstructive coronary artery disease. Design Prospective observational study. Methods Subjects were recruited from 1002 asymptomatic recreational cyclists completing a 91-km mountain bike race (North Sea Race Endurance Exercise Study). No subject had known cardiovascular disease or took cardiovascular medication. Blood samples were collected within 24 h before and 3 h and 24 h after the race. Coronary computed tomography angiography was performed in 80 participants with the highest post-exercise cTnI and in 40 reference subjects with moderately elevated cTnI values. Results Study subjects ( N = 120) were 45 (36–52) years old and 74% were male. There were similar demographics in the High-cTnI group and the Reference group. The cTn concentrations were highest at 3 h post-race: cTnI, 224 (125–304) ng/L; cTnT, 89 (55–124) ng/L. Nine subjects had obstructive coronary artery disease on coronary computed tomography angiography, eight of whom were High-cTnI responders. Two subjects had myocardial bridging, both High-cTnI responders. Troponin concentrations at 24 h post-race were higher in subjects with obstructive coronary artery disease than in the rest of the cohort ( n = 109): cTnI, 151 (72–233) ng/L vs. 24 (19–82) ng/L, p = 0.005; cTnT, 39 (25–55) ng/L vs. 20 (14–31) ng/L, p = 0.002. The areas under the receiver operating characteristic curves for predicting obstructive coronary artery disease were 0.79, p = 0.005 (cTnI) and 0.82, p = 0.002 (cTnT). Conclusion In subjects with occult obstructive coronary artery disease there was a prolonged elevation of cTn following strenuous exercise.

Abstract 128: A Precision Medicine Test Accurately Rules Out Obstructive Coronary Artery Disease Among Non-Diabetic Patients Presenting to Emergency Department With Acute Chest Pain

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Khurram Nasir ◽  
Shozab S Ali ◽  
Anshul Saxena ◽  
Gowtham Grandhi ◽  
Usman Siddiqui ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Emergency Department ◽  
Chest Pain ◽  
Coronary Artery ◽  
Obstructive Coronary Artery Disease ◽  
Acute Chest Pain ◽  
Diabetic Patients ◽  
High Grade ◽  
Intermediate Risk ◽  
Artery Disease

Background: An age, sex, and blood gene expression score (ASGES) has been previously validated to detect obstructive coronary artery disease (CAD) in non-diabetic patients presenting with stable chest pain in the outpatient setting. However, the diagnostic performance of this test in ruling out obstructive CAD in patients presenting with acute chest pain (ACP) to the emergency department (ED) is unknown. Methods: In an ongoing study, 371 low-intermediate risk patients with ACP and no prior history of CAD (TIMI risk score ≤ 2, negative troponins and normal/non-diagnostic ECG) underwent coronary CT angiography (CCTA) using institutional protocols. Patients were classified based on severity of stenosis (obstructive CAD, >50%; high grade stenosis, >70%) and ASGES. The ASGES blood test sample was drawn before ED discharge and analyzed in a commercial reference laboratory (Redwood City, CA). We excluded 23 (6%) patients with unreportable ASGES and 47 (13%) diabetics from this primary analysis. Results: 301 (53±10 years, 45% males, 78% Hispanics) non-diabetic ACP patients undergoing CCTA in an ED setting were included in this analysis. No plaque was detected in 183 (60%) patients, and 22 (7%) patients had obstructive CAD. In this population, 51% of patients had scores below the previously defined threshold of ASGES≤ 15. This threshold yielded sensitivity, specificity, NPV, and PPV of 71% (52-86%), 53% (47-59%), 97% (93-98%), and 12% (9-14%) for obstructive CAD. Furthermore, ASGES≤15 yielded a 100% sensitivity and NPV for patients with high grade stenosis (n=7, 2%). In a multivariable analysis including patient demographics and clinical covariates, ASGES ≤15 was significantly associated with obstructive CAD (OR: 0.15, 95% CI: 0.04-0.62). As a continuous variable, increasing ASGES was positively correlated with the presence of obstructive CAD and CCTA-defined plaque burden (p<0.0001). Conclusions: This is the first study validating the use of this blood-based precision medicine test to rule out obstructive CAD among low-intermediate risk non-diabetic patients presenting with ACP in ED setting. 30-day follow-up is underway to evaluate the prognostic implications of these findings.

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