title: Usefulness of multislice spiral computed tomography coronary angiography in patients with acute chest pain in the emergency department.
abstract: BACKGROUND
  Despite reports that multislice spiral computed tomography (MSCT) has high sensitivity and specificity in preselected patient populations, the routine clinical feasibility and utility of MSCT coronary angiography in patients with acute chest pain in the emergency department remains uncertain.
  
  
  OBJECTIVE
  We sought to determine whether 16-slice MSCT coronary angiography can provide diagnostically useful images in patients with acute chest pain in the emergency department.
  
  
  METHODS
  Ninety-eight patients in the emergency department (41 men, 57 women; mean age +/- SD, 48.1 +/- 11.9 y) with acute chest pain underwent MSCT coronary angiography. Coronary calcium (Agatston) scoring was performed, followed by contrast-enhanced MSCT. Images were evaluated for mean image quality (MIQ) and for degree of stenosis. These data were correlated with body mass index (BMI; in kg/m(2)), heart rate, beat-to-beat variation, and calcium score to assess their influence on image quality.
  
  
  RESULTS
  The 28 patients (29%) with nondiagnostic MIQs had significantly higher BMIs (mean +/- SD, 32.9 +/- 9.1 vs 28.9 +/- 6.7; P < 0.05) and heart rates (mean +/- SD, 71.0 +/- 11.9 beats/min vs 65.6 +/- 9.9 beats/min; P < 0.05) than patients with diagnostic MIQs. Forty-five patients (46%) had at least 1 nondiagnostic coronary segment. These patients had significantly higher heart rates (mean +/- SD, 70.5 +/- 10.3 vs 64.1 +/- 13.7; P < 0.05) than patients with only diagnostic-quality scans. Image quality correlated inversely and strongly with BMI and heart rate.
  
  
  CONCLUSIONS
  Sixteen-slice MSCT coronary angiography cannot routinely provide diagnostically useful images in patients with acute chest pain in the emergency department.
authors.affiliation: Department of Radiology, the Texas Heart Institute, St Luke's Episcopal Hospital, Houston, TX, USA.
authors.forename: Steffen
authors.initials: S
authors.lastname: Huber
authors.forename: Martin
authors.initials: M
authors.lastname: Huber
authors.forename: Debra
authors.initials: D
authors.lastname: Dees
authors.forename: Frank A
authors.initials: FA
authors.lastname: Redmond
authors.forename: James M
authors.initials: JM
authors.lastname: Wilson
authors.forename: Scott D
authors.initials: SD
authors.lastname: Flamm
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed / Q000379:methods*