Impact of 64-slice coronary CT on the management of patients presenting with acute chest pain: results of a prospective two-centre study.
OBJECTIVE
Our two-centre prospective study evaluates the usefulness of 64-slice coronary computed tomography (CCT) to rule out significant coronary artery stenosis in patients admitted in emergency departments (ED) for acute coronary syndromes (ACS) with low-to-intermediate risk score.


METHODS
Patients (175) admitted for acute chest pain (ACP), unmodified electrocardiogram and first troponin measurement within normal ranges were included. A second troponin measurement and a 64-slice CCT within 24 h were performed. Major adverse cardiac events (MACE) were recorded during follow-up (6 months ± 2).


RESULTS
64-slice CCT was either normal or showed non-significant coronary stenosis in the majority of patients (78%). 64-slice CCT depicted significant stenosis (>50% diameter) in 22% of patient whereas initial clinical and biological evaluation was reassuring. For negative CCTs, elevated troponin at second measurement did not modify the strategy or treatment of patients. No MACEs were noted during follow up. In 12% of patients CCT identified unsuspected non-coronary abnormalities.


CONCLUSIONS
Our study confirms 64-slice CCT utility to rule out significant coronary artery stenosis in 8/10 patients admitted in ED with ACP or ACS with low-to-intermediate risk score. Early discharge with a negative 64-slice CCT is associated with very low risk of cardiac events at 6 months.


CONCLUSIONS
• 64-slice coronary computed tomography (CCT) offers a critical role in acute chest pain. • 64-slice CCT allows differentiation between significant and non-significant coronary artery stenosis. • Normal 64-slice CCT allows rapid discharge of patients with ACP. • 64-slice CCT helps make appropriate therapeutic decision in patients with ACP.
Département d'imagerie Cardiovasculaire, Assistance Publique- Hôpitaux de Paris, Hôpital Lariboisière, Paris, France.
Luc
L
Christiaens
Florent
F
Duchat
Mourad
M
Boudiaf
Jean-Pierre
JP
Tasu
Yann
Y
Fargeaudou
Olivier
O
Ledref
Philippe
P
Soyer
Marc
M
Sirol
D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000453:epidemiology; D000208:Acute Disease; D002637:Chest Pain / Q000000981:diagnostic imaging* / Q000453:epidemiology; D017023:Coronary Angiography / Q000706:statistics & numerical data*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003937:Diagnosis, Differential; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*