CARDIAC IMAGING AND NON-INVASIVE TESTING

64-Slice CT coronary angiography in patients with non-ST elevation acute coronary syndrome

Willem B Meijboom¹, Nico R Mollet¹, Carlos A Van Mieghem¹, Annick C Weustink¹, Francesca Pugliese¹, Niels van Pelt¹, Filippo Cademartiri², Eleni Vourvouri¹, Peter de Jaegere¹, Gabriel P Krestin², Pim J de Feyter¹

¹ Department of Cardiology, Thoraxcenter, and Radiology, Rotterdam, The Netherlands
² Department of Radiology, Rotterdam, The Netherlands

Dr P J de Feyter, Department of Cardiology and Radiology, Thoraxcenter, Room Ba 589, Erasmus MC, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; p.j.defeyter{at}erasmusmc.nl

Background: A high diagnostic accuracy of 64-slice CT coronary angiography (CTCA) has been reported in selected patients with stable angina pectoris, but only scant information is available in patients with non-ST elevation acute coronary syndrome (ACS).

Objectives: To study the diagnostic performance of 64-slice CTCA in patients with non-ST elevation ACS.

Patients and methods: 64-slice CTCA was performed in 104 patients (mean (SD) age 59 (9) years) with non-ST elevation ACS. Two independent, blinded observers assessed all coronary arteries for stenosis, using conventional quantitative angiography as a reference. Coronary lesions with 50% luminal narrowing were classified as significant.

Results: Conventional coronary angiography demonstrated the absence of significant disease in 15% (16/104) of patients, and the presence of single-vessel disease in 40% (42/104) and multivessel disease in 44% (46/104) of patients. Sensitivity for detecting significant coronary stenoses on a patient-by-patient analysis was 100% (88/88; 95% CI 95 to 100), specificity 75% (12/16; 95% CI 47 to 92), and positive and negative predictive values were 96% (88/92; 95% CI 89 to 99) and 100% (12/12; 95% CI 70 to 100), respectively.

Conclusion: 64-slice CTCA has a high sensitivity to detect significant coronary stenoses, and is reliable to exclude the presence of significant coronary artery disease in patients who present with a non-ST elevation ACS.

Abbreviations: ACS, acute coronary syndrome; CABG, coronary artery bypass graft; CAD, coronary artery disease; CCA, conventional coronary angiography; CTCA, CT coronary angiography; PCI, percutaneous coronary intervention; QCA, quantitative coronary angiography

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