Morsbach Fabian, Hinzpeter Ricarda, Higashigaito Kai, Benz David, Manka Robert, Keller Dagmar I, Alkadhi Hatem
1 Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
2 Department of Cardiology, University Heart Center Zurich, University of Zurich, Zurich, Switzerland.
Acta Radiol. 2018 Nov;59(11):1309-1315. doi: 10.1177/0284185118758121. Epub 2018 Feb 27.
Background Computed tomography (CT) for excluding acute aortic syndrome (AAS) and pulmonary embolism (PE) simultaneously in patients with chest pain could be used to exclude coronary artery disease (CAD). Purpose To evaluate the frequency of further testing for CAD in patients receiving a CT in the emergency department (ED) for simultaneous evaluation for AAS and PE. Material and Methods This retrospective study was conducted over a three-year period including all patients with acute chest pain visiting our ED. All patients were included that received an electrocardiography (ECG)-gated CT of the entire chest enquiring simultaneously for AAS and PE. Those patients were followed up for 30 days after their initial ED visit whether they received further testing for CAD. Results Within the study period, a total of 157 patients with acute chest pain received a chest pain CT for simultaneous evaluation of both AAS and PE. Image quality was deemed sufficient to evaluate the coronary arteries in 80% of the patients. Thirty-seven patients (24%) underwent additional testing for CAD within 30 days of their ED visit, including catheter coronary angiography (n = 25), cardiac-stress single-photon emission-CT (n = 6), and cardiac magnetic resonance imaging (MRI) (n = 6). Conclusion Of patients presenting to the ED with acute chest pain who received a chest pain CT for simultaneous evaluation of AAS and PE, 24% had further imaging for CAD within 30 days of the initial ED visit. Immediate evaluation of the coronary arteries as part of a chest pain CT should be considered here for not delaying diagnosis.
对于胸痛患者，计算机断层扫描（CT）可同时排除急性主动脉综合征（AAS）和肺栓塞（PE），也可用于排除冠状动脉疾病（CAD）。目的：评估在急诊科（ED）接受CT检查以同时评估AAS和PE的患者中，进一步进行CAD检查的频率。材料与方法：本回顾性研究为期三年，纳入了所有因急性胸痛就诊于我院急诊科的患者。纳入所有接受全胸部心电图（ECG）门控CT检查以同时排查AAS和PE的患者。对这些患者在首次急诊科就诊后30天进行随访，了解他们是否接受了进一步的CAD检查。结果：在研究期间，共有157例急性胸痛患者接受了胸痛CT检查以同时评估AAS和PE。80%的患者图像质量足以评估冠状动脉。37例患者（24%）在急诊科就诊后30天内接受了额外的CAD检查，包括导管冠状动脉造影（n = 25）、心脏负荷单光子发射CT（n = 6）和心脏磁共振成像（MRI）（n = 6）。结论：在因急性胸痛就诊于急诊科并接受胸痛CT检查以同时评估AAS和PE的患者中，24%在首次急诊科就诊后30天内接受了进一步的CAD成像检查。在此应考虑将冠状动脉的即时评估作为胸痛CT的一部分，以免延误诊断。
