Efficacy of multislice computed tomography for the detection of acute coronary syndrome in the emergency department.
BACKGROUND
The diagnosis of acute coronary syndrome (ACS), especially non-ST-elevation myocardial infarction and unstable angina in the emergency department (ED) still remains a challenge. Multislice computed tomography (MSCT) allows assessment of not only coronary artery stenoses and occlusions, but also assessment of coronary artery plaques and myocardial perfusion status.


RESULTS
MSCT was performed in 31 patients who were admitted to the ED because of chest pain persisting at least 30 min and non-diagnostic ECG changes and normal serum enzyme concentrations. Using MSCT, ACS was defined by coronary artery stenosis > or = 75% accompanied by computed tomography (CT)-low-density plaques, and/or by the presence of myocardial perfusion defects. ACS was confirmed by coronary stenosis > or = 75% by coronary angiography and/or subsequent elevation of troponin I concentration. In total, 22 patients were diagnosed as having ACS. MSCT detected stenoses with CT-low-density plaques in 21 and non-transmural myocardial perfusion defect in 3 patients. There was 1 false-positive and 1 false-negative result. The sensitivity and specificity of MSCT to identify ACS was 95.5% and 88.9%, respectively.


CONCLUSIONS
MSCT provides diagnostic operating characteristics suitable for triage of patients with ACS in the ED.
Sato
Yuichi
Y
Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan. yuichis@med.nihon-u.ac.jp
Matsumoto
Naoya
N
Ichikawa
Makoto
M
Kunimasa
Taeko
T
Iida
Kiyoshi
K
Yoda
Shunichi
S
Takayama
Tadateru
T
Uchiyama
Takahisa
T
Saito
Satoshi
S
Nagao
Ken
K
Tanaka
Hiroshi
H
Inoue
Fumio
F
Furuhashi
Satoru
S
Takahashi
Motoichiro
M
Koyama
Yasushi
Y
D000208:Acute Disease; D000328:Adult; D000368:Aged; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging*; D036542:Tomography, Spiral Computed / Q000379:methods