scholarly journals Comparison of Traditional Cardiovascular Risk Models and Coronary Atherosclerotic Plaque as Detected by Computed Tomography for Prediction of Acute Coronary Syndrome in Patients With Acute Chest Pain

2012 ◽  
Vol 19 (8) ◽  
pp. 934-942 ◽  
Author(s):  
Maros Ferencik ◽  
Christopher L. Schlett ◽  
Fabian Bamberg ◽  
Quynh A. Truong ◽  
John H. Nichols ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Coronary Syndrome ◽  
Cardiovascular Risk ◽  
Chest Pain ◽  
Atherosclerotic Plaque ◽  
Acute Chest Pain ◽  
Risk Models ◽  
Coronary Syndrome ◽  
Coronary Atherosclerotic Plaque

Abstract 1900: Coronary MDCT based Detection of Coronary Stenosis and Plaque in the Assessment of Patients with Acute Chest Pain: Update from ROMICAT I

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Udo Hoffmann ◽  
Fabian Bamberg ◽  
Sujith Seneviratne ◽  
Ian S Rogers ◽  
Quynh A Truong ◽  
...  
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Atherosclerotic Plaque ◽  
Cardiac Ct ◽  
Coronary Artery Stenosis ◽  
Acute Chest Pain ◽  
Artery Stenosis ◽  
Significant Coronary Artery Stenosis ◽  
Coronary Syndrome ◽  
Coronary Atherosclerotic Plaque

Objective : To determine CT angiographic patterns of coronary plaque and stenosis and diagnostic test characteristics of these findings to predict ACS in patients presenting with acute chest pain to the emergency department (ED). Methods : We conducted a blinded, prospective, observational cohort study in patients presenting with acute chest pain to the ED between May 2005 and July 2006, who were admitted to the hospital to rule out acute coronary syndrome (ACS) with no ischemic ECG changes and negative initial biomarkers. Contrast-enhanced 64-slice cardiac CT was performed immediately before admission and caregivers were blinded to the cardiac CT results. An expert panel determined the presence or absence of ACS (unstable angina pectoris [UAP], Non-ST-Elevation Myocardial Infarction [MI] according to AHA/ACC criteria). Two independent observers evaluated cardiac CT data sets for the presence of (1) coronary atherosclerotic plaque, and (2) significant coronary artery stenosis (>50%). Results: Of 221 consecutive patients (44% female, mean age 55±12 years), 31 patients had ACS (10 NSTEMI, 21 UAP). The presence of any coronary atherosclerotic plaque could be excluded in 82 patients (37%). None of these subjects was determined to have ACS (Sensitivity and NPV: 100%, (95% CI: 0.91–1.00 and 0.96–1.00; respectively). The presence of a significant coronary artery stenosis could be excluded in 152 subjects (69%). Overall, three of these patients had ACS during the index hospitalization (NPV, 98 %; 95% CI: 0.94–1.00). In 69 patients (31%), a significant stenosis was either detected or could not be completely excluded. Among them were 28/31 patients with ACS (specificity: 78%, 95% CI: 0.72– 0.84; PPV: 41% 95% CI: 0.29 – 0.53). Conclusions : These data extend initial observations that nearly 40% and 70% of patients with acute chest pain demonstrate no detectable CAD or no significant coronary artery stenosis on cardiac MDCT, respectively. Randomized diagnostic trials are warranted to determine how this information will be used by ED physicians and whether it will decrease the number of unnecessary admissions.

Diagnostic Capacity of 64-Slice Multidetector Computed Tomography for Acute Coronary Syndrome in Patients Presenting with Acute Chest Pain

Cardiology ◽  
2009 ◽  
Vol 112 (3) ◽  
pp. 211-218 ◽  
Author(s):  
Koji Ueno ◽  
Toshihisa Anzai ◽  
Masahiro Jinzaki ◽  
Minoru Yamada ◽  
Takashi Kohno ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Multidetector Computed Tomography ◽  
Acute Chest Pain ◽  
Coronary Syndrome ◽  
Diagnostic Capacity

scholarly journals Current Role of Computed Tomography in the Evaluation of Acute Coronary Syndrome

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 266
Author(s):  
Min Ji Son ◽  
Seung Min Yoo ◽  
Dongjun Lee ◽  
Hwa Yeon Lee ◽  
In Sup Song ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Acute Chest Pain ◽  
Review Article ◽  
Current Role ◽  
Coronary Syndrome ◽  
Ct Findings

This review article provides an overview regarding the role of computed tomography (CT) in the evaluation of acute chest pain (ACP) in the emergency department (ED), focusing on characteristic CT findings.

scholarly journals Clinical utility of two-phase computed tomography angiography for the detection of myocardial perfusion defects related to acute coronary syndrome in patients with acute chest pain: a case series

2021 ◽  
Vol 5 (4) ◽  
Author(s):  
Enrique Vallejo ◽  
Christian Buelna-Cano
Keyword(s):  
Computed Tomography ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Computed Tomography Angiography ◽  
Case Series ◽  
Acute Chest Pain ◽  
Cardiac Biomarkers ◽  
Two Phase ◽  
Imaging Protocol ◽  
Coronary Syndrome

Abstract Background Evaluation of acute chest pain (ACP) in the emergency department is a major health issue and differential diagnosis remains challenging for the physician, particularly in patients with atypical symptoms and inconclusive changes in electrocardiogram (ECG) or biomarkers levels. Case summary We present the potential value of the two-phase computed tomography angiography (TP-CTA) imaging protocol done in six different patients evaluated with ACP and underwent non-gated or gated computed tomography angiography (CTA) to exclude pulmonary embolism (PE), acute aortic syndrome (AAS), or acute coronary syndrome (ACS). All patients had new-onset chest pain and atypical clinical presentation with non-diagnostic ECG and initially negative or near-normal cardiac biomarkers. Discussion The evaluation of myocardial computed tomography perfusion (MCTP) using TP-CTA imaging protocol might open a new diagnostic approach to evaluate MCTP in patients with ACP related to PE, AAS, or ACS.

Abstract 681: Characteristics of Atherosclerotic Plaque Burden in Patients With and Without Acute Coronary Syndrome Presenting With Acute Chest Pain to the Emergency Department

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Fabian Bamberg ◽  
Maros Ferecik ◽  
Quynh Truong ◽  
Ian Rogers ◽  
Michael Shapiro ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Coronary Arteries ◽  
Atherosclerotic Plaque ◽  
Acute Chest Pain ◽  
Coronary Plaque ◽  
Plaque Burden ◽  
Coronary Syndrome ◽  
Coronary Ct ◽  
Calcified Plaque

Background: Coronary computed tomography (CT) may improve the early triage of patients with acute chest pain in the emergency department (ED). The aim of this study was to compare the presence and extent of coronary atherosclerotic plaque as detected by coronary CT in patients with and without acute coronary syndromes (ACS). Methods: The study was designed as a prospective, observational cohort study in patients with acute chest pain but negative cardiac biomarkers and no diagnostic ECG changes, admitted to rule out myocardial ischemia. All patients underwent coronary CT prior to hospital admission. The presence of coronary plaque was treated as a dichotomous outcome, and the extent of CAD was defined as number of (1) coronary segments with plaque, or (2) major coronary arteries with plaque detected by MDCT as assessed by two independent observers. The clinical outcome (ACS) was adjudicated by a review committee using established AHA criteria; subjects with history of CAD (stent placement, bypass) were excluded. Results : Among 368 patients with acute chest pain (mean age 53±12 years, 61% male) 31 patients were determined to have ACS (8%). None of the 183 subjects without plaque (50%) had an ACS. Among the remaining 185 subjects (mean age 58.0±11.5 years, 68% male) in whom coronary plaque was detected, patients with ACS had a significantly more plaque (7.2±3.7 vs. 4.2±3.4, p<0.0001 segments) as compared to subjects without ACS. Similar results were seen for calcified plaque and non-calcified plaque (6.5±3.7 vs. 3.6±3.5 segments, p<0.0001; and 3.6±3.2 vs. 1.8±2.2 segments, p<0.0001, respectively). In addition, the rate of ACS increased with the number of major coronary arteries with plaque (1-vessel: 6.8%, 2-vessels: 10.6%, 3 vessels: 30.8%, and 4-vessels: 25%; p<0.01). In contrast, the ratio of non-calcified to calcified plaque was not different between patients with and without ACS (0.68±0.6 vs. 0.54±0.72, p=0.31). Conclusions: The extent of coronary plaque differs between subjects with and without ACS among patients presenting with acute chest pain. Detailed assessment of the extent and composition of coronary plaque may be helpful to assess risk of ACS among patients with acute chest pain but inconclusive initial ED evaluation.

Sign in / Sign up

Export Citation Format

Share Document