title: Diagnostic accuracy and clinical outcomes of ECG-gated, whole chest CT in the emergency department.
abstract: OBJECTIVE
  The purpose of this study was to assess the diagnostic accuracy and one year prognosis of whole chest, "multiple rule out" CT for coronary artery disease (CAD) in Emergency Department patients.
  
  
  RESULTS
  One hundred and two Emergency Department patients at low to intermediate risk of acute coronary syndrome (ACS), pulmonary embolism and/or acute aortic syndrome underwent a research 64 channel ECG-gated, whole chest CT and a standard of care evaluation. Patients were classified with obstructive CAD with either a coronary CT stenosis greater than 50% or a non-evaluable coronary segment. SOC and 3 month follow up data were used to determine an adjudicated clinical diagnosis. The diagnostic ability of obstructive CAD on CT to identify clinical diagnoses was determined. Patients were followed up for 1 year for cardiac events. Seven (7%) patients were diagnosed with ACS. CT sensitivity to detect obstructive CAD in ACS patients was 100% (95% CI 65%, 100%), negative predictive value 100% (96%, 100%), specificity 88% (80%, 94%), and positive predictive value 39% (17%, 64%). Pulmonary embolism and acute aortic syndrome were not identified in any patients. No cardiac events occurred in patients without obstructive CAD over 1 year.
  
  
  CONCLUSIONS
  Whole chest CT has high sensitivity and negative predictive value for ACS with excellent one year prognosis in patients without obstructive CAD on CT. The frequency of pulmonary embolism or acute aortic syndrome and the higher radiation dose suggest whole chest CT should be limited to select patients. ClinicalTrials.org #: NCT00855231.
authors.affiliation: Division of Cardiology, University of Washington, Seattle, Washington, United States of America. kbranch@u.washington.edu
authors.forename: Kelley R
authors.initials: KR
authors.lastname: Branch
authors.forename: Jared
authors.initials: J
authors.lastname: Strote
authors.forename: William P
authors.initials: WP
authors.lastname: Shuman
authors.forename: Lee M
authors.initials: LM
authors.lastname: Mitsumori
authors.forename: Janet M
authors.initials: JM
authors.lastname: Busey
authors.forename: Tessa
authors.initials: T
authors.lastname: Rue
authors.forename: James H
authors.initials: JH
authors.lastname: Caldwell
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging; D004562:Electrocardiography / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*