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Multislice computed tomography coronary angiography in patients admitted with a suspected acute coronary syndrome

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Abstract

Objectives

The aim of this prospective clinical study was to assess the accuracy and clinical relevance of multislice computed tomography coronary angiography (MSCTCA) in patients presenting with acute chest pain.

Background

Multislice computed tomography coronary angiography has shown ability to detect accurately coronary artery disease (CAD) in selected elective patient groups.

Methods

One hundred and twenty patients presenting with acute chest pain (<24 h) underwent MSCTCA (Siemens Sensation 16) before a scheduled inpatient conventional coronary angiogram (CCA). Exclusion criteria included patients with STEMI, non-sinus rhythm, contraindication to β blockers and renal impairment. Blinded visual assessment of MSCTCA to detect CAD was performed on an 11-segment model. The accuracy of MSCTCA was compared to CCA to detect significant stenoses (≥50%).

Results

One hundred and thirteen patients underwent both investigations. The prevalence of significant CAD was 74%. 1,243 native segments were assessed by MSCTCA. The overall ability of MSCTCA to detect the presence of ≥1 significant stenosis in all native segments had a sensitivity of 92% (95%CI 83–97%), specificity of 55% (95%CI 35–74%), positive predictive value of 86% (95%CI 76–93%) and negative predictive value of 70% (95%CI 47–87%). 22% of all segments (mostly distal) were non-analyzable. Coronary calcification was a major cause of false positivity.

Conclusion

In a prospective study of unselected patients presenting with acute chest pain, the diagnostic accuracy of 16-slice CT coronary angiography was moderate and less than reported from studies in elective patients. The clinical relevance of this technology to screen patients with acute chest pain is limited.

Condensed Abstract

Multislice CT coronary angiography (MSCTCA) and conventional coronary angiography (CCA) were used to assess 120 patients presenting with acute chest pain. MSCTCA was compared to CCA to detect significant stenoses (≥50%). In 113 directly comparable patients MSCTCA had a sensitivity of 92% (95%CI 83–97%) and specificity of 55% (95%CI 35–74%) to detect the presence of ≥1 significant stenosis in all native segments. In this patient cohort with a high prevalence of coronary disease and coronary calcification, the accuracy and clinical relevance of 16 slice MSCTCA to screen and risk stratify patients with acute chest pain is limited.

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Abbreviations

BMI:

Body mass index

CABG:

Coronary artery bypass graft

CCA:

Conventional coronary angiography

COPD:

Chronic obstructive pulmonary disease

CT:

Computed tomography

ECG:

Electrocardiogram

MSCT:

Multislice computed tomography

MSCTCA:

Multislice computed tomography coronary angiography

STEMI:

ST elevation myocardial infarction

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Acknowledgements

Dr. Coles was supported by an educational grant from Siemens, Forchheim, Germany. British Heart Foundation grants supported the cardiac Multislice CT scanner at the Bristol Royal Infirmary and Dr. Rogers. Thanks are given to the radiographers assisting with the project and to Stuart Metcalfe for database construction.

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Authors and Affiliations

  1. Department of Cardiology, Bristol Royal Infirmary, Bristol, BS2 8HW, UK

    Duncan R. Coles, Martin Oberhoff, Chris A. Rogers, Karl R. Karsch & Andreas Baumbach

  2. Department of Clinical Radiology, Bristol Heart Institute, Bristol Royal Infirmary, Bristol, UK

    Peter Wilde

Authors
  1. Duncan R. Coles
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  2. Peter Wilde
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  3. Martin Oberhoff
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  4. Chris A. Rogers
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  5. Karl R. Karsch
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  6. Andreas Baumbach
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Correspondence to Andreas Baumbach.

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Coles, D.R., Wilde, P., Oberhoff, M. et al. Multislice computed tomography coronary angiography in patients admitted with a suspected acute coronary syndrome. Int J Cardiovasc Imaging 23, 603–614 (2007). https://doi.org/10.1007/s10554-006-9193-5

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  • DOI: https://doi.org/10.1007/s10554-006-9193-5

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