Prevalence of first-pass myocardial perfusion defects detected by contrast-enhanced dual-source CT in patients with non-ST segment elevation acute coronary syndromes.
OBJECTIVE
To investigate the prevalence and diagnostic value of first-pass myocardial perfusion defects (PD) visualised by contrast-enhanced multidetector computed tomography (MDCT) in patients admitted for a first acute coronary syndrome (ACS).


METHODS
Thirty-eight patients with non-ST segment elevation myocardial infarction (NSTEMI) or unstable angina (UA) and scheduled for percutaneous coronary intervention underwent dual-source CT immediately before catheterisation. CT images were analysed for the presence of any PD by using a 17-segment model. Results were compared with peak cardiac troponin-I (cTnI) and angiography findings.


RESULTS
PD were seen in 21 of the 24 patients with NSTEMI (median peak cTnI level 7.07 ng/mL; range 0.72-37.07 ng/mL) and in 2 of 14 patients with UA. PD corresponded with the territory of the infarct-related artery in 20 out of 22 patients. In a patient-based analysis, sensitivity, specificity, negative and positive predictive values of any PD for predicting NSTEMI were 88%, 86%, 80% and 91%. Per culprit artery, the respective values were 86%, 75%, 80% and 83%.


CONCLUSIONS
In patients with non-ST segment elevation ACS, first-pass myocardial PD in contrast-enhanced MDCT correlate closely with the presence of myocardial necrosis, as determined by increases in cTnI levels.
Department of Internal Medicine 2 (Cardiology), University of Erlangen, Erlangen, Germany. tiziano.schepis@gmx.ch
Tiziano
T
Schepis
Stephan
S
Achenbach
Mohamed
M
Marwan
Gerd
G
Muschiol
Dieter
D
Ropers
Werner G
WG
Daniel
Tobias
T
Pflederer
D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018376:Cardiovascular Abnormalities / Q000175:diagnosis*; D003287:Contrast Media; D004635:Emergency Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D015588:Observer Variation; D010146:Pain; D013902:Radiography, Thoracic; D014057:Tomography, X-Ray Computed
D003287:Contrast Media