Coronary CT angiography outperforms calcium imaging in the triage of acute coronary syndrome

https://doi.org/10.1016/j.ijcard.2012.04.099Get rights and content
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Abstract

Background

In this prospective study we determine the diagnostic value of coronary CT angiography (CTA) and calcium imaging in low to intermediate risk acute chest pain patients.

Methods

One hundred and eleven consecutive patients (57 ± 11 years, 71 males) presenting to the emergency department with chest pain suggestive of acute coronary syndrome (ACS), but without indication for immediate catheter angiography, underwent both coronary CTA and calcium imaging without disclosure of the findings to the treating physicians.

Results

ACS was diagnosed in 19 patients (17%). Coronary calcium was present in 71 patients (64%). Coronary CTA identified 74 (67%) patients with coronary plaque and 36 (32%) patients with obstructive (≥ 50%) plaque. The sensitivity and specificity of the calcium scan were: 89% and 41%. The sensitivity and specificity of coronary CTA were: 100% and 40% based on the presence of any plaque and 89% and 79% based on the presence of > 50% stenosis.

C-statistics of the GRACE risk score (0.77 [95% CI 0.66–0.89]) improved after addition of coronary CTA (0.93 [0.88–0.98], p < 0.01), though not after addition of calcium scores (0.81 [0.71–0.91], p = 0.52).

Follow-up at 3 months revealed four late revascularizations (no deaths or myocardial infarctions), all of whom had obstructive CAD with calcium on CT at presentation.

Conclusions

Coronary CTA outperforms calcium imaging in the triage of patients suspected of developing ACS. Absence of plaque on coronary CTA allows safe discharge. Coronary CTA has incremental value to clinical risk scores and has the potential to reduce unnecessary hospital admissions.

Keywords

Tomography, X-ray computed
Calcinosis/radiography
Emergency service, hospital
Acute coronary syndrome
Sensitivity and specificity

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