Coronary artery diseaseUsefulness of 64-Slice Multidetector Computed Tomography in Diagnostic Triage of Patients With Chest Pain and Negative or Nondiagnostic Exercise Treadmill Test Result
Section snippets
Patient sample
The study was a retrospective analysis of the findings in 103 consecutive patients evaluated for chest pain symptoms who had a negative or nondiagnostic ETT result and who were referred for MDCT during a 10-week period by their treating physician. Exclusion criteria were cardiac arrhythmias, such as atrial fibrillation or other tachyarrhythmias, abnormal renal function (serum creatinine >1.3 mg/dl), inability to perform a short 10- to 15-second breath-hold, or known allergy to radiographic
Multidetector coronary computed tomographic image quality
MDCT scans of diagnostic quality were obtained in 100 of 103 patients (97%). Scans with significant motion artifacts in 2 patients and with heavy calcifications in another were excluded from further analysis. Thus, overall image quality was good in 83 patients, moderate in 17, and severely suboptimal in 3 (excluded). MDCT results are presented on a per-patient basis and a per-segment analysis in comparisons with invasive angiography. In the segmental analysis, 94% of coronary segments were
Discussion
Obstructive CAD was diagnosed using MDCT in 22% of patients with a negative ETT result and excluded obstructive CAD in 61% of patients with a nondiagnostic ETT result. In symptomatic patients with negative or nondiagnostic ETT results, the prevalence of obstructive disease generally is low to moderate. In this population, MDCT would be expected to have a high negative predictive value and may be superior to physiologic testing. In patients referred for invasive angiography despite a negative
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ACR Appropriateness Criteria® Chest Pain-Possible Acute Coronary Syndrome
2020, Journal of the American College of RadiologyCitation Excerpt :In stable patients with suggested ACS at low or intermediate risk of adverse events, a noninvasive coronary imaging test (ie, coronary CTA [CCTA]) is a proven alternative to stress testing or selective coronary angiography [19,59,60]. CCTA has a very high negative predictive value for the detection of coronary atherosclerosis with or without significant stenosis and is an alternative to stress imaging in the emergency department and inpatient settings in patients at low to intermediate risk for CAD [59,61-64]. Large randomized controlled trials (eg, CT-STAT, ROMICAT I and II, ACRIN-PA, PROSPECT, CT-COMPARE, CATCH, and CATCH-2) have amply established the high negative predictive value (eg, safe discharge) and good prognosis of a negative CCTA in low- to intermediate-risk patients suspected of ACS when compared with standard pathways that predominantly involve stress nuclear MPI [65-72].
Coronary computed tomography and triple rule out CT in patients with acute chest pain and an intermediate cardiac risk profile. Part 1: Impact on patient management
2013, European Journal of RadiologyCitation Excerpt :A large number of studies including meta-analysis have demonstrated a high negative predictive value for coronary CTA and TRO-CTA for the exclusion of significant coronary artery stenosis [10,15–20]. Moreover, a limited number of studies have demonstrated [14,15,17] that coronary CTA may improve management and reduce overall costs of patients with acute chest pain and a low pretest likelihood of ACS [7,9,21,22]. The radiation dose of TRO-CTA observed in our study was approximately 30% higher when compared to a standard coronary CTA protocol.
ACR appropriateness Criteria® on chest pain, suggestive of acute coronary syndrome
2011, Journal of the American College of RadiologyClinical management and short-term cost - 64-slice MDCT vs. myocardial perfusion scintigraphy
2010, International Journal of CardiologyMulti-detector computerized tomography angiography for evaluation of acute chest pain - A meta analysis and systematic review of literature
2010, International Journal of CardiologyComparison of Usefulness of Exercise Testing Versus Coronary Computed Tomographic Angiography for Evaluation of Patients Suspected of Having Coronary Artery Disease
2010, American Journal of CardiologyCitation Excerpt :Regardless of the exercise test outcome, CTA revealed a similar proportion of patients with apparently normal coronary arteries, with nonsignificant, and significant CAD. In concordance with the results by Rubinshtein et al,23 a non-negligible proportion of patients with negative exercise test results had significant CAD in the present investigation. Furthermore, a large proportion of patients with negative exercise test results had nonsignificant CAD (Figure 2).