Department of Cardiology, University Hospital of Rangueil, 1, avenue Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France.
Arch Cardiovasc Dis. 2012 Jun-Jul;105(6-7):338-46. doi: 10.1016/j.acvd.2012.04.001. Epub 2012 Jun 27.
Multislice computed tomography coronary angiography (MSCT-CA) is feasible in the emergency department (ED) for ruling out obstructive coronary artery disease (CAD).
To investigate a diagnostic strategy using MSCT-CA for the early triage of patients presenting to the ED with acute chest pain suggestive of acute coronary syndrome (ACS), according to the medium-term incidence of clinical events.
We conducted a single-centre, prospective, observational cohort study in 123 patients with low-risk to intermediate-risk acute chest pain suggestive of ACS. MSCT-CA was performed using dual-source 64-slice computed tomography with retrospective electrocardiographic gating. Patients without coronary artery lesions were discharged from the ED. The incidences of death, myocardial infarction and myocardial revascularization were collected during a mid-term follow-up.
According to MSCT-CA, 93 patients (75.6%) had no CAD or coronary artery stenosis less or equal to 50% and 28 patients (22.8%) had stenosis more or equal to 50%. Invasive coronary angiography was performed in 29 patients (23.6%). MSCT-CA accurately identified ten patients (8.13%) with obstructive CAD requiring myocardial revascularization; all had a low TIMI score (0-2) and eight had a low GRACE score. The mean estimated effective dose of MSCT-CA was 16.3±6.4 mSv. Median follow-up was 15 months. No patient (95% CI 0-3.0%) had major adverse cardiovascular events during follow-up.
MSCT-CA appears to be a useful initial triage tool in the ED. When the MSCT-CA result is negative, it allows safe early discharge because of its high negative predictive value. In a significant number of cases of low-risk ACS, MSCT-CA detects severe coronary lesions and allows further dedicated diagnostic and therapeutic intervention. Reduction of radiation exposure would help acceptance in clinical practice.
多排螺旋计算机断层扫描冠状动脉造影（MSCT-CA）可在急诊科（ED）用于排除阻塞性冠状动脉疾病（CAD）。
根据中期临床事件发生率，探讨一种使用 MSCT-CA 对因急性冠状动脉综合征（ACS）疑似急性胸痛就诊 ED 的患者进行早期分诊的诊断策略。
我们对 123 例低至中度风险 ACS 疑似急性胸痛患者进行了单中心前瞻性观察性队列研究。使用双源 64 层 CT 进行 MSCT-CA，采用回顾性心电图门控。无冠状动脉病变的患者从 ED 出院。在中期随访期间收集死亡、心肌梗死和血运重建的发生率。
根据 MSCT-CA，93 例（75.6%）患者无 CAD 或冠状动脉狭窄<或=50%，28 例（22.8%）患者狭窄>或=50%。29 例（23.6%）患者行有创冠状动脉造影。MSCT-CA 准确识别出 10 例（8.13%）需要血运重建的阻塞性 CAD 患者；所有患者 TIMI 评分均较低（0-2），8 例患者 GRACE 评分较低。MSCT-CA 的平均估算有效剂量为 16.3±6.4 mSv。中位随访时间为 15 个月。随访期间无患者（95%CI 0-3.0%）发生重大不良心血管事件。
MSCT-CA 似乎是 ED 中有用的初始分诊工具。当 MSCT-CA 结果为阴性时，由于其高阴性预测值，可安全地早期出院。在大量低危 ACS 病例中，MSCT-CA 可检测到严重的冠状动脉病变，并允许进一步进行专门的诊断和治疗干预。减少辐射暴露将有助于在临床实践中得到认可。
