Utility of coronary computed tomography to rule out acute coronary syndrome in the emergency department: a pilot study

Miró O, Tomás Ortiz-Pérez J, León R, López Seoane B, Perea R, De Caralt TM, Sitges M, Paredes Arranz C, Bosch X, Bragulat E

Objective: To analyze the diagnostic contribution of coronary multidetector computed

tomography (CMCT) in low-risk chest pain patients.

Methods: Retrospective, descriptive substudy as part of a prospective study of the

diagnostic yield of stress echocardiography in comparison with CMCT angiography. The

setting was a non-traumatic chest pain unit. Patients with chest pain but without

diagnosed coronary artery disease and fewer than 2 coronary risk factors in 2008 were

included if the information usually gathered to diagnose acute coronary syndrome (ACS)

(ie, medical history, electrocardiogram, troponin series, and ergometry) was negative.

Clinical and patient data were recorded and CMCT was performed; if abnormalities were

detected, heart catheterism was undertaken.

Results: Of the 502 patients suspected of having ACS while CMCT was available to the

department, 54 (10.7%) met the criteria for performing the procedure. CMCT

demonstrated normal coronary arteries in 35 (64.8%). In 3 (5.5%) the findings could

not be interpreted due to artifacts and in 16 (29.6%), abnormalities were detected.

Catheterization was performed in 15 of the 16 patients; the test was positive in 10.

CMCT led to a diagnosis of ACS in an additional 2% of the group of patients in whom

the diagnosis was initially suspected and in 18.5% of the 54 patients included in the

CMCT study.

Conclusions: CMCT contributed additional diagnoses of ACS when the procedure was

used to complement the standard protocol (history, ECG, troponin series, and

ergometry) in patients with chest pain.

Bosch X, Bragulat E, De Caralt TM, León R, López Seoane B, Miró O, Paredes Arranz C, Perea R, Sitges M, Tomás Ortiz-Pérez J