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Role of 64-slice cardiac computed tomography in the evaluation of patients with non-ST-elevation acute coronary syndrome

Ruolo della TC volumetrica cardiaca (64 strati) nella valutazione di pazienti con sindrome coronarica acuta di tipo NSTEMI

  • Cardiac Radiology/Cardioradiologia
  • Published:
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Abstract

Purpose

This study was done to evaluate the feasibility, sensitivity and specificity of 64-slice computed tomography (CT) in identifying haemodynamically significant (>50%) coronary artery stenoses in patients with suspected acute coronary syndrome (ACS) by correlating the CT findings with the clinical event and data provided by conventional coronary angiography (CCA).

Materials and methods

Sixty-four patients (38 men and 26 women; mean age 65 years; range±10 years) presenting to our hospital’s emergency department with a clinical suspicion of ACS were studied with 64-slice CT followed by CCA within 24 h of arrival.

Results

Two patients (3.1%) were excluded from the analysis due to artefacts. Per-patient analysis in the remaining 62 patients identified 24 cases (38.7%) of negative CT findings (no stenoses or stenoses <50%), 35 cases of positive CT findings (56.4%) with identification of the culprit lesion, two cases in which the culprit lesion was not identified and one patient with unconfirmed stenosis. Sensitivity and specificity were 94.6% and 96%, respectively. Per-vessel analysis (186 vessels) revealed 17 non-evaluable vessels (9.1%) due to motion artefacts, 61 vessels (32.8%) with stenosis >50%, seven overestimated vessels (3.7%) due to extensive calcifications, three vessels (1.6%) with underestimated stenosis and 98 vessels (52.6%) without stenosis. Sensitivity and specificity were 95.3% and 93.3%, respectively.

Conclusions

In this type of emergency, coronary CT angiography could lead to considerably lower healthcare costs by identifying patients without coronary disease and allowing immediate discharge without any need for further diagnostic procedures.

Riassunto

Obiettivo

Scopo di questo lavoro è stato valutare fattibilità, sensibilità e specificità della tomografia computerizzata (TC)-volumetrica a 64 strati nell’identificazione di stenosi emodinamicamente significative (>50%) delle arterie coronarie in soggetti con sospetta sindrome coronarica acuta (SCA), correlando il reperto TC con l’evento clinico del paziente e confrontando successivamente i dati ottenuti con quelli della coronarografia convenzionale (CC).

Materiali e metodi

Sessantaquattro pazienti (38 maschi e 26 femmine, età 65±10 anni) pervenuti presso il Pronto Soccorso (PS) del nostro policlinico universitario con sospetta SCA sono stati sottoposti a TC-volumetrica a 64strati e a successiva CC entro 24 ore dalla presentazione in PS.

Risultati

Due pazienti (3,1%) sono stati totalmente esclusi per artefatti. L’analisi per paziente dei rimanenti 62 ha visto 24 pazienti (38,7%) negativi allo studio TC (stenosi assenti o <50%), 35 pazienti (56,4%) positivi, con identificazione della lesione culprit, 2 pazienti dove non è stato possibile identificare la lesione culprit ed 1 paziente con stenosi non confermata; sensibilità e specificità sono risultate del 94,6% e del 96%. L’analisi globale per coronaria (186 vasi) ha evidenziato 17 vasi (9,1% non valutabili per artefatti da movimento, 61 vasi (32,8%) con stenosi>50%, 7 vasi (3,7%) sovrastimati per presenza di estese calcificazioni, 3 vasi (1,6%) sottostimati circa la significatività della stenosi e 98 vasi (52,6%) privi di stenosi. I valori della sensibilità e della specificità sono risultati del 95,3% e del 93,3%.

Conclusioni

L’utilizzo della coronaro-TC nella pratica clinica, in questo tipo di emergenze, potrebbe incidere in maniera ragguardevole sui costi del Sistema Sanitario, stratificando i pazienti privi di patologia coronarica o di altra patologia e consentendone la dimissione in tempi immediati, senza necessità di ulteriori indagini diagnostiche.

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Authors and Affiliations

  1. Dipartimento di Diagnostica per Immagini, Imaging Molecolare, Radiologia Interventistica e Radioterapia, Università di Tor Vergata, Viale Oxford 81, 00133, Roma, Italy

    A. Romagnoli, M. Sperandio, C. Arganini, B. De Angelis, V. Acampora, A. Patrei, G. Bazzocchi & G. Simonetti

  2. Cattedra di Cardiologia, Dipartimento di Medicina Interna, Università di Tor Vergata, Roma, Italy

    E. Martuscelli & F. Romeo

Authors
  1. A. Romagnoli
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  2. E. Martuscelli
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  3. M. Sperandio
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  4. C. Arganini
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  5. B. De Angelis
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  6. V. Acampora
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  7. A. Patrei
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  8. G. Bazzocchi
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  9. F. Romeo
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  10. G. Simonetti
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Corresponding author

Correspondence to C. Arganini.

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Romagnoli, A., Martuscelli, E., Sperandio, M. et al. Role of 64-slice cardiac computed tomography in the evaluation of patients with non-ST-elevation acute coronary syndrome. Radiol med 115, 341–353 (2010). https://doi.org/10.1007/s11547-009-0482-7

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  • DOI: https://doi.org/10.1007/s11547-009-0482-7

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