title: Multislice computed tomography coronary angiography in patients admitted with a suspected acute coronary syndrome.
abstract: OBJECTIVE
  The aim of this prospective clinical study was to assess the accuracy and clinical relevance of multislice computed tomography coronary angiography (MSCTCA) in patients presenting with acute chest pain.
  
  
  BACKGROUND
  Multislice computed tomography coronary angiography has shown ability to detect accurately coronary artery disease (CAD) in selected elective patient groups.
  
  
  METHODS
  One hundred and twenty patients presenting with acute chest pain (<24 h) underwent MSCTCA (Siemens Sensation 16) before a scheduled inpatient conventional coronary angiogram (CCA). Exclusion criteria included patients with STEMI, non-sinus rhythm, contraindication to beta blockers and renal impairment. Blinded visual assessment of MSCTCA to detect CAD was performed on an 11-segment model. The accuracy of MSCTCA was compared to CCA to detect significant stenoses (> or =50%).
  
  
  RESULTS
  One hundred and thirteen patients underwent both investigations. The prevalence of significant CAD was 74%. 1,243 native segments were assessed by MSCTCA. The overall ability of MSCTCA to detect the presence of > or =1 significant stenosis in all native segments had a sensitivity of 92% (95%CI 83-97%), specificity of 55% (95%CI 35-74%), positive predictive value of 86% (95%CI 76-93%) and negative predictive value of 70% (95%CI 47-87%). 22% of all segments (mostly distal) were non-analyzable. Coronary calcification was a major cause of false positivity.
  
  
  CONCLUSIONS
  In a prospective study of unselected patients presenting with acute chest pain, the diagnostic accuracy of 16-slice CT coronary angiography was moderate and less than reported from studies in elective patients. The clinical relevance of this technology to screen patients with acute chest pain is limited.
authors.affiliation: Department of Cardiology, Bristol Royal Infirmary, Bristol BS2 8HW, UK.
authors.forename: Duncan R
authors.initials: DR
authors.lastname: Coles
authors.forename: Peter
authors.initials: P
authors.lastname: Wilde
authors.forename: Martin
authors.initials: M
authors.lastname: Oberhoff
authors.forename: Chris A
authors.initials: CA
authors.lastname: Rogers
authors.forename: Karl R
authors.initials: KR
authors.lastname: Karsch
authors.forename: Andreas
authors.initials: A
authors.lastname: Baumbach
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D015203:Reproducibility of Results; D012107:Research Design; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed