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European Radiology

, Volume 22, Issue 5, pp 1050–1058 | Cite as

Impact of 64-slice coronary CT on the management of patients presenting with acute chest pain: results of a prospective two-centre study

  • Luc Christiaens
  • Florent Duchat
  • Mourad Boudiaf
  • Jean-Pierre Tasu
  • Yann Fargeaudou
  • Olivier Ledref
  • Philippe Soyer
  • Marc SirolEmail author
Cardiac

Abstract

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.

Conclusion

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.

Key Points

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.

Keywords

Coronary artery disease Acute coronary syndrome Computed tomorgraphy Risk stratification Chest pain clinic 

Notes

Acknowledgements

This work was partially supported by the Société Française de Cardiologie, Paris (France). We thank Prof. Daniel Henkle (Senior Lecturer and Course Coordinator in Medical English, Université Paris Diderot) for editing and revision of the manuscript. We thank also the Department of Clinical Cardiology (Prof. P. Henry) and Emergency department (Prof. P. Plaisance and Dr S. Laribi) for their contribution and support to the study.

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Copyright information

© European Society of Radiology 2011

Authors and Affiliations

  • Luc Christiaens
    • 1
    • 3
  • Florent Duchat
    • 1
  • Mourad Boudiaf
    • 1
  • Jean-Pierre Tasu
    • 4
  • Yann Fargeaudou
    • 1
  • Olivier Ledref
    • 1
  • Philippe Soyer
    • 1
  • Marc Sirol
    • 1
    • 2
    • 5
    Email author
  1. 1.Département d’imagerie Cardiovasculaire, Assistance Publique- Hôpitaux de Paris, Hôpital LariboisièreParisFrance
  2. 2.INSERM UFR U942, Insuffisance Cardiaque et Biomarqueurs, Université Paris 7 - Denis Diderot, Hôpital LariboisièreParisFrance
  3. 3.Département de CardiologieCHU de PoitiersPoitiersFrance
  4. 4.Département de RadiologieCHU de PoitiersPoitiersFrance
  5. 5.Université Paris VII - Denis Diderot, Assistance Publique - Hôpitaux de Paris, Service de Radiologie Vasculaire, Hôpital LariboisièreParisFrance

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