Rubinshtein Ronen, Halon David A, Gaspar Tamar, Jaffe Ronen, Karkabi Basheer, Flugelman Moshe Y, Kogan Asia, Shapira Reuma, Peled Nathan, Lewis Basil S
Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Circulation. 2007 Apr 3;115(13):1762-8. doi: 10.1161/CIRCULATIONAHA.106.618389. Epub 2007 Mar 19.
Multidetector computed tomography (MDCT) has high diagnostic value for detecting or excluding coronary artery stenosis. We examined performance characteristics of MDCT for diagnosing or excluding an acute coronary syndrome in patients presenting to the emergency department (ED) with possible ischemic chest pain and examined relation to clinical outcome during a 15-month follow-up period.
We prospectively studied 58 patients (56+/-10 years of age, 36% female) with chest pain possibly ischemic in origin and no new ECG changes or elevated biomarkers. The patients underwent 64-slice contrast-enhanced MDCT, which showed normal coronary vessels (no or trivial atheroma) in 15 patients, nonobstructive plaque in 20 (MDCT-negative patients), and obstructive coronary disease (> or = 50% luminal narrowing) in 23 (MDCT-positive group). By further investigation (new elevation of cardiac biomarkers, abnormal myocardial perfusion scintigraphy and/or invasive angiography), acute coronary syndrome was diagnosed in 20 of the 23 MDCT-positive patients (ED MDCT sensitivity 100% [20/20], specificity 92% [35/38], positive predictive value 87% [20/23], negative predictive value 100% [35/35]). During a 15-month follow-up period, no deaths or myocardial infarctions occurred in the 35 patients discharged from the ED after initial triage and MDCT findings. One patient underwent late percutaneous coronary intervention (late major adverse cardiovascular events rate, 2.8%). Overall, ED MDCT sensitivity for predicting major adverse cardiovascular events (death, myocardial infarction, or revascularization) during hospitalization and follow-up was 92% (12/13), specificity was 76% (34/45), positive predictive value was 52% (12/23), and negative predictive value was 97% (34/35).
We found that 64-slice cardiac MDCT is a potentially valuable diagnostic tool in ED patients with chest pain of uncertain origin, providing early direct noninvasive visualization of coronary anatomy. ED MDCT had high positive predictive value for diagnosing acute coronary syndrome, whereas a negative MDCT study predicted a low rate of major adverse cardiovascular events and favorable outcome during follow-up.
多排螺旋计算机断层扫描（MDCT）在检测或排除冠状动脉狭窄方面具有很高的诊断价值。我们研究了MDCT对急诊科（ED）出现可能的缺血性胸痛患者诊断或排除急性冠状动脉综合征的性能特征，并研究了其与15个月随访期临床结局的关系。
我们前瞻性地研究了58例胸痛可能源于缺血且无新的心电图变化或生物标志物升高的患者（年龄56±10岁，36%为女性）。患者接受了64层对比增强MDCT检查，其中15例显示冠状动脉正常（无或轻度动脉粥样硬化），20例显示非阻塞性斑块（MDCT阴性患者），23例显示阻塞性冠状动脉疾病（管腔狭窄≥50%，MDCT阳性组）。通过进一步检查（心脏生物标志物新升高、心肌灌注闪烁显像异常和/或有创血管造影），23例MDCT阳性患者中有20例被诊断为急性冠状动脉综合征（ED MDCT敏感性100%[20/20]，特异性92%[35/38]，阳性预测值87%[20/23]，阴性预测值100%[35/35]）。在15个月的随访期内，35例经初始分诊和MDCT检查后从ED出院的患者未发生死亡或心肌梗死。1例患者接受了晚期经皮冠状动脉介入治疗（晚期主要不良心血管事件发生率为2.8%）。总体而言，ED MDCT预测住院和随访期间主要不良心血管事件（死亡、心肌梗死或血运重建）的敏感性为92%（12/13），特异性为76%（34/45），阳性预测值为52%（12/23），阴性预测值为97%（34/35）。
我们发现，64层心脏MDCT对病因不明的胸痛ED患者是一种潜在有价值的诊断工具，可早期直接无创显示冠状动脉解剖结构。ED MDCT对诊断急性冠状动脉综合征具有很高的阳性预测值，而MDCT检查结果为阴性则预测主要不良心血管事件发生率较低且随访期间结局良好。
