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



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.


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).


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.


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.


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



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.


  1. 1.
    Mehta RH, Eagle KA (2000) Missed diagnoses of acute coronary syndromes in the emergency room–continuing challenges. N Engl J Med 342:1207–10PubMedCrossRefGoogle Scholar
  2. 2.
    Bassand J-P, Hamm CW, Ardissino D et al (2007) Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. Eur Heart J 28:1598–1660PubMedCrossRefGoogle Scholar
  3. 3.
    Stillman AE, Oudkerk M, Ackerman M et al (2007) Use of multidetector computed tomography for the assessment of acute chest pain: a consensus statement of the North American Society of Cardiac Imaging and the European Society of Cardiac Radiology. Eur Radiol 17:2196–207PubMedCrossRefGoogle Scholar
  4. 4.
    Hoffmann U, Bamberg F, Chae CU et al (2009) Coronary computed tomography angiography for early triage of patients with acute chest pain: the ROMICAT (Rule Out Myocardial Infarction using Computer Assisted Tomography) trial. J Am Coll Cardiol 53:1642–1650PubMedCrossRefGoogle Scholar
  5. 5.
    Wijns W, Kolh P, Danchin N et al (2010) Guidelines on myocardial revascularization: the task force on myocardial revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 31:2501–55PubMedCrossRefGoogle Scholar
  6. 6.
    Braunwald E, Antman EM, Beasley JW et al (2002) ACC/AHA guideline update for the Management of Patients With Unstable Angina and non-ST-segment elevation myocardial infarction—2002: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina). Circulation 106:1893–1900PubMedCrossRefGoogle Scholar
  7. 7.
    Lee TH, Goldman L (2000) Evaluation of the patient with acute chest pain. N Engl J Med 342:1187–1195PubMedCrossRefGoogle Scholar
  8. 8.
    Antman EM, Cohen M, Bernink PJ et al (2000) The TIMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making. JAMA 284:835–842PubMedCrossRefGoogle Scholar
  9. 9.
    Rubinshtein R, Halon DA, Gaspar T et al (2007) Usefulness of 64-Slice cardiac computed tomographic angiography for diagnosing acute coronary syndromes and predicting clinical outcome in emergency department patients with chest pain of uncertain origin. Circulation 115:1762–1768PubMedCrossRefGoogle Scholar
  10. 10.
    Raff GL, Gallagher MJ, O’Neill WW, Goldstein JA (2005) Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J Am Coll Cardiol 46:552–557PubMedCrossRefGoogle Scholar
  11. 11.
    Leber AW, Becker A, Knez A et al (2006) Accuracy of 64-slice computed tomography to classify and quantify plaque volumes in the proximal coronary system: a comparative study using intravascular ultrasound. J Am Coll Cardiol 47:672–677PubMedCrossRefGoogle Scholar
  12. 12.
    Hundt W, Rust F, Stabler A, Wolff H, Suess C, Reiser M (2005) Dose reduction in multislice computed tomography. J Comput Assist Tomogr 29:140–147PubMedCrossRefGoogle Scholar
  13. 13.
    Lehman SJ, Abbara S, Cury RC et al (2009) Significance of cardiac computed tomography incidental findings in acute chest pain. Am J Med 122:543–549PubMedCrossRefGoogle Scholar
  14. 14.
    Valentin J (2007) Managing patient dose in multi-detector computed tomography (MDCT). Ann ICRP 37:1–79Google Scholar
  15. 15.
    Oudkerk M, Stillman AE, Halliburton SS et al (2008) Coronary artery calcium screening: current status and recommendations from the European Society of Cardiac Radiology and North American Society for Cardiovascular Imaging. Eur Radiol 18:2785–807PubMedCrossRefGoogle Scholar
  16. 16.
    Hamon M, Morello R, Riddell JW, Hamon M (2007) Coronary arteries: diagnostic performance of 16- versus 64-section spiral CT compared with invasive coronary angiography—meta-analysis. Radiology 245:720–731PubMedCrossRefGoogle Scholar
  17. 17.
    Mark DB, Berman DS, Budoff MJ et al (2010) ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 expert consensus document on coronary computed tomographic angiography: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. Circulation 121:2509–2543PubMedCrossRefGoogle Scholar
  18. 18.
    Hamon M, Biondi-Zoccai GGL, Malagutti P et al (2006) Diagnostic performance of multislice spiral computed tomography of coronary arteries as compared with conventional invasive coronary angiography: a meta-analysis. J Am Coll Cardiol 48:1896–1910PubMedCrossRefGoogle Scholar
  19. 19.
    Hollander JE, Chang AM, Shofer FS, McCusker CM, Baxt WG, Litt HI (2009) Coronary computed tomographic angiography for rapid discharge of low-risk patients with potential acute coronary syndromes. Ann Emerg Med 53:295–304PubMedCrossRefGoogle Scholar
  20. 20.
    Beigel R, Oieru D, Goitein O et al (2009) Usefulness of routine use of multidetector coronary computed tomography in the “fast track” evaluation of patients with acute chest pain. Am J Cardiol 103:1481–1486PubMedCrossRefGoogle Scholar
  21. 21.
    Laudon DA, Behrenbeck TR, Wood CM et al (2010) Computed tomographic coronary artery calcium assessment for evaluating chest pain in the emergency department: long-term outcome of a prospective blind study. Mayo Clin Proc 85:314–322PubMedCrossRefGoogle Scholar
  22. 22.
    Goldstein JA, Gallagher MJ, O’Neill WW, Ross MA, O’Neil BJ, Raff GL (2007) A randomized controlled trial of multi-slice coronary computed tomography for evaluation of acute chest pain. J Am Coll Cardiol 49:863–871PubMedCrossRefGoogle Scholar
  23. 23.
    Lai C, Noeller TP, Schmidt K, King P, Emerman CL (2003) Short-term risk after initial observation for chest pain. J Emerg Med 25:357–362PubMedCrossRefGoogle Scholar
  24. 24.
    Goodacre S, Nicholl J, Dixon S et al (2004) Randomised controlled trial and economic evaluation of a chest pain observation unit compared with routine care. BMJ 328:254PubMedCrossRefGoogle Scholar
  25. 25.
    Pope JH, Aufderheide TP, Ruthazer R et al (2000) Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med 342:1163–1170PubMedCrossRefGoogle Scholar
  26. 26.
    Januzzi JL Jr, Bamberg F, Lee H et al (2010) High-sensitivity troponin T concentrations in acute chest pain patients evaluated with cardiac computed tomography. Circulation 121:1227–1234PubMedCrossRefGoogle Scholar
  27. 27.
    Reichlin T, Hochholzer W, Stelzig C et al (2009) Incremental value of copeptin for rapid rule out of acute myocardial infarction. J Am Coll Cardiol 54:60–68PubMedCrossRefGoogle Scholar
  28. 28.
    Schepis T, Achenbach S, Marwan M et al (2010) Prevalence of first-pass myocardial perfusion defects detected by contrast-enhanced dual-source CT in patients with non-ST segment elevation acute coronary syndromes. Eur Radiol 20:1607–14PubMedCrossRefGoogle Scholar
  29. 29.
    Manini AF, Dannemann N, Brown DF et al (2009) Limitations of risk score models in patients with acute chest pain. Am J Emerg Med 27:43–48PubMedCrossRefGoogle Scholar
  30. 30.
    Motoyama S, Kondo T, Sarai M et al (2007) Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes. J Am Coll Cardiol 50:319–326PubMedCrossRefGoogle Scholar
  31. 31.
    Gallagher MJ, Ross MA, Raff GL, Goldstein JA, ONeill WW, ONeil B (2007) The diagnostic accuracy of 64-slice computed tomography coronary angiography compared with stress nuclear imaging in emergency department low-risk chest pain patients. Ann Emerg Med 49:125–136PubMedCrossRefGoogle Scholar
  32. 32.
    Hamid S, Bainbridge F, Kelly A-M, Kerr D (2010) What proportion of patients with chest pain are potentially suitable for computed tomography coronary angiography? Am J Emerg Med 28:494–498PubMedCrossRefGoogle Scholar
  33. 33.
    Athappan G, Habib M, Ponniah T, Jeyaseelan L (2010) Multi-detector computerized tomography angiography for evaluation of acute chest pain — A meta analysis and systematic review of literature. Int J Cardiol 141:132–140PubMedCrossRefGoogle Scholar
  34. 34.
    Khare RK, Courtney DM, Powell ES, Venkatesh AK, Lee TA (2008) Sixty-four-slice computed tomography of the coronary arteries: cost-effectiveness analysis of patients presenting to the emergency department with low-risk chest pain. Acad Emerg Med 15:623–32PubMedCrossRefGoogle Scholar
  35. 35.
    Ladapo JA, Hoffmann U, Bamberg F et al (2008) Cost-effectiveness of coronary MDCT in the triage of patients with acute chest pain. Am J Roentgenol 191:455–463CrossRefGoogle Scholar

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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