title: Use of multi-slice computed tomography in patients with chest-pain submitted to the emergency department.
abstract: This study evaluates calcium scoring (CS) and computed tomography angiography (MSCTA) in patients >50 years with chest-pain submitted to the emergency department utilising CS as a "diagnostic filter" upfront. Results of CS and MSCTA performed by a 64-slice CT scanner were compared to invasive coronary angiography (ICA). 289 consecutive symptomatic patients (185 men, mean age 71.3 ± 6.4 years) were included. In patients with CS = 0 (Group I; n = 60) or CS > 400 (Group III; n = 95) we refrained from MSCTA, whereas patients with CS 1-400 (Group II; n = 134) underwent subsequent MSCTA. ICA detected significant coronary artery disease (CAD) in 162 patients (56.1%; male 98). None of Group I-patients showed CAD, but in Group III CAD prevalence increased to 82.1%. In Group II, MSCTA correctly identified 177/190 significantly diseased vessel segments. Compared to CS alone, our approach increased sensitivity to 98.1% (+1.8%), specificity to 82.6% (+27.5%) and negative predictive value (NPV) to 97.2% (+5.1%) as well as positive predictive value to 87.8% (+14.6%), respectively. Overall DA was 91.3%. Stratification of symptomatic patients into three different risk groups according to CS results with concomitantly increasing disease prevalence is possible. Zero calcium was found to exclude significant CAD, but needs further evaluation. Still server calcifications impair image quality in MSCTA. Thus direct referral to ICA might be a reasonable approach in case of high CS. In patients with intermediate CS, MSCTA is able to rule out significant CAD with a high NPV.
authors.affiliation: Department of Cardiology, Ludwig-Maximilians-University, Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany, franz.ziegler@med.uni-muenchen.de.
authors.forename: Franz
authors.initials: F
authors.lastname: von Ziegler
authors.forename: Jan
authors.initials: J
authors.lastname: Schenzle
authors.forename: Stephan
authors.initials: S
authors.lastname: Schiessl
authors.forename: Martin
authors.initials: M
authors.lastname: Greif
authors.forename: Susanne
authors.initials: S
authors.lastname: Helbig
authors.forename: Janine
authors.initials: J
authors.lastname: Tittus
authors.forename: Christoph
authors.initials: C
authors.lastname: Becker
authors.forename: Alexander
authors.initials: A
authors.lastname: Becker
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging* / Q000453:epidemiology; D016507:Cardiology Service, Hospital / Q000706:statistics & numerical data*; D017023:Coronary Angiography / Q000379:methods / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D061205:Vascular Calcification / Q000000981:diagnostic imaging* / Q000453:epidemiology
references.citation: J Am Coll Cardiol. 2010 Feb 16;55(7):627-34
references.pmid: 20170786
references.citation: BMC Cardiovasc Disord. 2012 Dec 04;12:116
references.pmid: 23206557
references.citation: Radiology. 2010 Oct;257(1):158-66
references.pmid: 20851940
references.citation: J Am Coll Cardiol. 2011 Dec 6;58(24):2533-40
references.pmid: 22079127
references.citation: Atherosclerosis. 2009 Apr;203(2):533-7
references.pmid: 18774135
references.citation: J Am Coll Cardiol. 2002 Oct 2;40(7):1366-74
references.pmid: 12383588
references.citation: AJR Am J Roentgenol. 2005 May;184(5):1413-9
references.pmid: 15855088
references.citation: Circulation. 1975 Apr;51(4 Suppl):5-40
references.pmid: 1116248
references.citation: Circulation. 2005 Mar 15;111(10):1313-20
references.pmid: 15769774
references.citation: J Nucl Cardiol. 2012 Apr;19(2):364-76
references.pmid: 22322526
references.citation: N Engl J Med. 2000 Apr 20;342(16):1207-10
references.pmid: 10770988
references.citation: Am J Cardiol. 2004 May 1;93(9):1150-2
references.pmid: 15110209
references.citation: J Cardiovasc Comput Tomogr. 2013 May-Jun;7(3):182-91
references.pmid: 23849491
references.citation: Acad Radiol. 2012 Nov;19(11):1316-23
references.pmid: 22897947
references.citation: J Am Coll Cardiol. 2001 Feb;37(2):451-7
references.pmid: 11216962
references.citation: Circulation. 2010 Nov 23;122(21):e525-55
references.pmid: 20975004
references.citation: Radiology. 1998 Sep;208(3):807-14
references.pmid: 9722864
references.citation: Int J Cardiol. 2013 Sep 1;167(5):2013-7
references.pmid: 22633672
references.citation: Radiology. 1994 Sep;192(3):619-23
references.pmid: 8058924
references.citation: Int J Cardiol. 2010 May 28;141(2):132-40
references.pmid: 19185936
references.citation: N Engl J Med. 2000 Apr 20;342(16):1163-70
references.pmid: 10770981
references.citation: Dtsch Med Wochenschr. 2005 Oct 28;130(43):2433-8
references.pmid: 16240241
references.citation: JACC Cardiovasc Imaging. 2009 Jun;2(6):675-88
references.pmid: 19520336
references.citation: J Am Coll Cardiol. 2004 Mar 3;43(5):831-9
references.pmid: 14998625
references.citation: Int J Cardiovasc Imaging. 2012 Apr;28(4):943-53
references.pmid: 21667273
references.citation: Circulation. 2004 Aug 3;110(5):588-636
references.pmid: 15289388
references.citation: Biometrics. 1977 Mar;33(1):159-74
references.pmid: 843571