Nagori M, Narain V S, Saran R K, Dwivedi S K, Sethi R
Department of Cardiology, KGMU, LKO, UP, India.
Department of Cardiology, KGMU, LKO, UP, India.
Indian Heart J. 2014 Jul-Aug;66(4):435-42. doi: 10.1016/j.ihj.2014.05.026. Epub 2014 Jul 3.
To compare the safety and diagnostic efficacy of coronary computed tomography angiography (CTA) with exercise electrocardiography (XECG) in triaging patients of low risk acute chest pain.
Noninvasive assessment of coronary stenosis by CTA may improve early and accurate triage of patients presenting with acute chest pain to the emergency department (ED).
Low risk patients of possible acute coronary syndrome (ACS) were included in the study. The patients in CTA arm with significant stenosis (≥ 50%) underwent catheterization, while those with no or intermediate stenosis (<50%) were discharged from ED and followed up periodically for six months for major adverse cardiovascular events (MACE). The same protocol was applied for XECG arm. Outcomes included: safety and diagnostic efficacy.
A total of 81 (41 CTA and 40 XECG) patients were enrolled. In this study CTA was observed to be 100% sensitive and 95.7% specific in diagnosing MACE in low risk patients of chest pain presenting to the ED, with a PPV of 94.7% and an NPV of 100%.The overall diagnostic efficacy was 97.6%. XECG was observed to be 72.7% sensitive and 96.6% specific in diagnosing MACE with a PPV of 88.9% and NPV of 90.3% in low risk chest pain patients presenting to the ED. The overall diagnostic accuracy was 90%.
CTA is an excellent diagnostic tool in ED patients with low risk of ACS, with minimum time delay as compared to XECG, and also is safe for triaging such patients.
比较冠状动脉计算机断层扫描血管造影（CTA）与运动心电图（XECG）在低风险急性胸痛患者分诊中的安全性和诊断效能。
通过CTA对冠状动脉狭窄进行无创评估，可能会改善急诊科（ED）中急性胸痛患者的早期准确分诊。
纳入可能患有急性冠状动脉综合征（ACS）的低风险患者。CTA组中存在显著狭窄（≥50%）的患者接受导管插入术，而无狭窄或中度狭窄（<50%）的患者从ED出院，并定期随访六个月以观察主要不良心血管事件（MACE）。XECG组采用相同方案。结果包括：安全性和诊断效能。
共纳入81例患者（41例CTA组和40例XECG组）。在本研究中，CTA在诊断ED中低风险胸痛患者的MACE方面，敏感性为100%，特异性为95.7%，阳性预测值为94.7%，阴性预测值为100%。总体诊断效能为97.6%。在诊断ED中低风险胸痛患者的MACE方面，XECG的敏感性为72.7%，特异性为96.6%，阳性预测值为88.9%，阴性预测值为90.3%。总体诊断准确性为90%。
CTA是诊断ACS低风险ED患者的优秀诊断工具，与XECG相比，时间延迟最短，并且对这类患者进行分诊也是安全的。
