title: Performance and efficacy of 320-row computed tomography coronary angiography in patients presenting with acute chest pain: results from a clinical registry.
abstract: The purpose of this study was to evaluate the performance of 320-row computed tomography angiography (CTA) in the identification of significant coronary artery disease (CAD) in patients presenting with acute chest pain and to examine the relation to outcome during follow-up. A total of 106 patients with acute chest pain underwent CTA to evaluate presence of CAD. Each CTA was classified as: normal, non-significant CAD (<50% luminal narrowing) and significant CAD (≥50% luminal narrowing). CTA results were compared with quantitative coronary angiography. After discharge, the following cardiovascular events were recorded: cardiac death, non-fatal infarction, and unstable angina requiring revascularization. Among the 106 patients, 23 patients (22%) had a normal CTA, 19 patients (18%) had non-significant CAD on CTA, 59 patients (55%) had significant CAD on CTA, and 5 patients (5%) had non-diagnostic image quality. In total, 16 patients (15%) were immediately discharged after normal CTA and 90 patients (85%) underwent invasive coronary angiography. Sensitivity, specificity, and positive and negative predictive values to detect significant CAD on CTA were 100, 87, 93, and 100%, respectively. During mean follow-up of 13.7 months, no cardiovascular events occurred in patients with a normal CTA examination. In patients with non-significant CAD on CTA, no cardiac death or myocardial infarctions occurred and only 1 patient underwent revascularization due to unstable angina. In patients presenting with acute chest pain, an excellent clinical performance for the non-invasive assessment of significant CAD was demonstrated using CTA. Importantly, normal or non-significant CAD on CTA predicted a low rate of adverse cardiovascular events and favorable outcome during follow-up.
authors: Department of Cardiology, Leiden University Medical Center, Postal zone: C5-P, P.O. Box 9600, 2333 ZA, Leiden, The Netherlands.
authors: J E
authors: JE
authors: van Velzen
authors: F R
authors: FR
authors: de Graaf
authors: L J
authors: LJ
authors: Kroft
authors: A
authors: A
authors: de Roos
authors: J H C
authors: JH
authors: Reiber
authors: J J
authors: JJ
authors: Bax
authors: J W
authors: JW
authors: Jukema
authors: J D
authors: JD
authors: Schuijf
authors: M J
authors: MJ
authors: Schalij
authors: E E
authors: EE
authors: van der Wall
references: JAMA. 2009 Feb 4;301(5):500-7
references: 19190314
references: Eur Heart J. 2007 Jul;28(13):1598-660
references: 17569677
references: JAMA. 2000 Aug 16;284(7):835-42
references: 10938172
references: Invest Radiol. 2010 Jun;45(6):331-40
references: 20404736
references: J Am Coll Cardiol. 2010 Nov 23;56(22):1864-94
references: 21087721
references: Am J Cardiol. 2010 Aug 15;106(4):463-9
references: 20691302
references: J Am Coll Cardiol. 2007 Aug 14;50(7):e1-e157
references: 17692738
references: J Cardiovasc Comput Tomogr. 2009 Mar-Apr;3(2):122-36
references: 19272853
references: Circulation. 2007 Apr 3;115(13):1762-8
references: 17372178
references: Circulation. 2006 Nov 21;114(21):2251-60
references: 17075011
references: Int J Cardiovasc Imaging. 2008 Jun;24(5):535-46
references: 18368512
references: Acad Emerg Med. 2009 Aug;16(8):693-8
references: 19594460
references: Eur Heart J. 2010 Aug;31(15):1908-15
references: 20047991
references: Circulation. 1975 Apr;51(4 Suppl):5-40
references: 1116248
references: Natl Health Stat Report. 2008 Aug 6;(7):1-38
references: 18958996
references: J Am Coll Cardiol. 2009 May 5;53(18):1642-50
references: 19406338
references: Heart. 2007 Nov;93(11):1386-92
references: 17344332
references: Heart. 2009 Oct;95(20):1656-61
references: 19581273
references: Eur Heart J. 2007 Oct;28(20):2525-38
references: 17951287
references: Circulation. 2009 Sep 8;120(10):867-75
references: 19704093
references: J Am Coll Cardiol. 2007 Feb 27;49(8):863-71
references: 17320744
references: Eur Heart J. 2010 Oct;31(20):2501-55
references: 20802248
references: Radiology. 2008 Aug;248(2):431-7
references: 18552312