Pôle cardiovasculaire interventionnel et d'imagerie, hôpital Privé Antony, rue Velpeau, 92160 Antony, France.
Pôle cardiovasculaire interventionnel et d'imagerie, hôpital Privé Antony, rue Velpeau, 92160 Antony, France.
Diagn Interv Imaging. 2015 Nov;96(11):1105-12. doi: 10.1016/j.diii.2014.09.005. Epub 2015 Mar 9.
Most patients presenting with acute chest pain (ACP) at the emergency unit do not have any marked electrocardiogram abnormalities or known history of heart disease. Identifying the few patients who have, or will actually develop acute coronary syndrome in this group that is considered to be at low risk, is an actual clinical challenge for emergency department physicians. In these patients, the goal of complementary non-invasive morphological or functional imaging tests is to exclude heart disease. The diagnostic values of coronary CT angiography include a sensitivity of 96% and a negative likelihood ratio of 0.09, which are highly contributory to the diagnosis, and the integration of this imaging test into a decision tree algorithm appears to be the least expensive strategy with the best cost/effective ratio. Coronary CT angiography is indicated in the presence of ACP associated with an inconclusive electrocardiogram, in the absence of any other obvious diagnoses, when the ultrasensitive troponin assay is negative or the dynamic changes are modest, slow and/or inconclusive. Ideally, coronary CT angiography should be performed within 3 to 48hours after the initial consultation.
大多数因急性胸痛（ACP）到急诊就诊的患者没有明显的心电图异常或已知的心脏病史。在这群被认为低危的患者中，识别出少数确实患有或将要发生急性冠状动脉综合征的患者是急诊医生面临的实际临床挑战。在这些患者中，补充非侵入性形态或功能成像检查的目的是排除心脏病。冠状动脉 CT 血管造影的诊断价值包括 96%的敏感性和 0.09 的阴性似然比，这对诊断有很大的帮助，并且将该影像学检查纳入决策树算法似乎是最具成本效益的最佳策略。当存在与心电图不明确相关的 ACP、无其他明显诊断、超敏肌钙蛋白检测为阴性或动态变化缓慢、轻微且/或不明确时，建议进行冠状动脉 CT 血管造影。理想情况下，应在初始咨询后 3 至 48 小时内进行冠状动脉 CT 血管造影。
