title: Diagnostic capacity of 64-slice multidetector computed tomography for acute coronary syndrome in patients presenting with acute chest pain.
abstract: OBJECTIVE
  Early evaluations of patients presenting with acute chest pain remain difficult. We examined the diagnostic capacity of multidetector computed tomography (MDCT) for acute coronary syndrome (ACS) in patients presenting with acute chest pain.
  
  
  RESULTS
  We examined 36 consecutive patients presenting with acute chest pain with neither diagnostic ECG changes nor elevated biomarkers. 64-slice MDCT was performed, and we evaluated the presenceof significant coronaryartery stenosis (>50% reduction in lumen diameter). Significant stenosis was detected in 15 patients by MDCT. Among them, 11 patients were diagnosed as having ACS based on the findings of coronary angiography or myocardial perfusion single photon emission computed tomography (positive predictive value 73%). All 21 patients without significant stenosis by MDCT, except only one, were regarded as not having ACS (negative predictive value 95%). Sensitivity and specificity were 92 and 83%, respectively. In patients without a history of coronary artery disease (CAD), both the specificity and positive predictive value improved to 100% (sensitivity 90%; negative predictive value 95%). In patients with neither a history of CAD nor coronary calcification, the diagnostic accuracy of MDCT was 100%.
  
  
  CONCLUSIONS
  MDCT has high diagnostic capacity for the early evaluation of ACS, especially in patients without a history of CAD or coronary calcification.
authors.affiliation: Department of Medicine, Division of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Ueno
authors.forename: Toshihisa
authors.initials: T
authors.lastname: Anzai
authors.forename: Masahiro
authors.initials: M
authors.lastname: Jinzaki
authors.forename: Minoru
authors.initials: M
authors.lastname: Yamada
authors.forename: Takashi
authors.initials: T
authors.lastname: Kohno
authors.forename: Akio
authors.initials: A
authors.lastname: Kawamura
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Yoshikawa
authors.forename: Sachio
authors.initials: S
authors.lastname: Kuribayashi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ogawa
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging*; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D002114:Calcinosis / Q000000981:diagnostic imaging; D002637:Chest Pain / Q000000981:diagnostic imaging*; D017023:Coronary Angiography / Q000379:methods* / Q000592:standards; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000592:standards
chemical_list: D015415:Biomarkers