Use of multi-slice computed tomography in patients with chest-pain submitted to the emergency department
This study evaluates calcium scoring (CS) and computed tomography angiography (MSCTA) in patients >50 years with chest-pain submitted to the emergency department utilising CS as a “diagnostic filter” upfront. Results of CS and MSCTA performed by a 64-slice CT scanner were compared to invasive cor...
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| Veröffentlicht in: | International Journal of Cardiovascular Imaging 2014, Vol.30 (1), p.145-153 |
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| container_title | International Journal of Cardiovascular Imaging |
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| creator | von Ziegler, Franz Schenzle, Jan Schiessl, Stephan Greif, Martin Helbig, Susanne Tittus, Janine Becker, Christoph Becker, Alexander |
| description | This study evaluates calcium scoring (CS) and computed tomography angiography (MSCTA) in patients >50 years with chest-pain submitted to the emergency department utilising CS as a “diagnostic filter” upfront. Results of CS and MSCTA performed by a 64-slice CT scanner were compared to invasive coronary angiography (ICA). 289 consecutive symptomatic patients (185 men, mean age 71.3 ± 6.4 years) were included. In patients with CS = 0 (Group I; n = 60) or CS > 400 (Group III; n = 95) we refrained from MSCTA, whereas patients with CS 1–400 (Group II; n = 134) underwent subsequent MSCTA. ICA detected significant coronary artery disease (CAD) in 162 patients (56.1 %; male 98). None of Group I-patients showed CAD, but in Group III CAD prevalence increased to 82.1 %. In Group II, MSCTA correctly identified 177/190 significantly diseased vessel segments. Compared to CS alone, our approach increased sensitivity to 98.1 % (+1.8 %), specificity to 82.6 % (+27.5 %) and negative predictive value (NPV) to 97.2 % (+5.1 %) as well as positive predictive value to 87.8 % (+14.6 %), respectively. Overall DA was 91.3 %. Stratification of symptomatic patients into three different risk groups according to CS results with concomitantly increasing disease prevalence is possible. Zero calcium was found to exclude significant CAD, but needs further evaluation. Still server calcifications impair image quality in MSCTA. Thus direct referral to ICA might be a reasonable approach in case of high CS. In patients with intermediate CS, MSCTA is able to rule out significant CAD with a high NPV. |
| doi_str_mv | 10.1007/s10554-013-0292-9 |
| format | Article |
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Results of CS and MSCTA performed by a 64-slice CT scanner were compared to invasive coronary angiography (ICA). 289 consecutive symptomatic patients (185 men, mean age 71.3 ± 6.4 years) were included. In patients with CS = 0 (Group I; n = 60) or CS > 400 (Group III; n = 95) we refrained from MSCTA, whereas patients with CS 1–400 (Group II; n = 134) underwent subsequent MSCTA. ICA detected significant coronary artery disease (CAD) in 162 patients (56.1 %; male 98). None of Group I-patients showed CAD, but in Group III CAD prevalence increased to 82.1 %. In Group II, MSCTA correctly identified 177/190 significantly diseased vessel segments. Compared to CS alone, our approach increased sensitivity to 98.1 % (+1.8 %), specificity to 82.6 % (+27.5 %) and negative predictive value (NPV) to 97.2 % (+5.1 %) as well as positive predictive value to 87.8 % (+14.6 %), respectively. Overall DA was 91.3 %. Stratification of symptomatic patients into three different risk groups according to CS results with concomitantly increasing disease prevalence is possible. Zero calcium was found to exclude significant CAD, but needs further evaluation. Still server calcifications impair image quality in MSCTA. Thus direct referral to ICA might be a reasonable approach in case of high CS. In patients with intermediate CS, MSCTA is able to rule out significant CAD with a high NPV.</description><identifier>ISSN: 1569-5794</identifier><identifier>EISSN: 1573-0743</identifier><identifier>EISSN: 1875-8312</identifier><identifier>DOI: 10.1007/s10554-013-0292-9</identifier><identifier>PMID: 24030295</identifier><identifier>CODEN: IJCIBI</identifier><language>eng</language><publisher>Dordrecht: Springer Netherlands</publisher><subject>Aged ; Angina Pectoris - diagnostic imaging ; Angina Pectoris - epidemiology ; Cardiac Imaging ; Cardiology ; Cardiology Service, Hospital - utilization ; Coronary Angiography - methods ; Coronary Angiography - utilization ; Coronary Artery Disease - diagnostic imaging ; Coronary Artery Disease - epidemiology ; Cross-Sectional Studies ; Emergency Service, Hospital - utilization ; Female ; Germany ; Humans ; Imaging ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Multidetector Computed Tomography - utilization ; Original Paper ; Predictive Value of Tests ; Prevalence ; Prognosis ; Prospective Studies ; Radiology ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; Vascular Calcification - diagnostic imaging ; Vascular Calcification - epidemiology</subject><ispartof>International Journal of Cardiovascular Imaging, 2014, Vol.30 (1), p.145-153</ispartof><rights>Springer Science+Business Media Dordrecht 2013</rights><rights>Springer Science+Business Media Dordrecht 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c405t-3bcf82407c2c5892be56be40cdef02a5a26b6a0f95c95a9747948c480f09759a3</citedby><cites>FETCH-LOGICAL-c405t-3bcf82407c2c5892be56be40cdef02a5a26b6a0f95c95a9747948c480f09759a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10554-013-0292-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10554-013-0292-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24030295$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>von Ziegler, Franz</creatorcontrib><creatorcontrib>Schenzle, Jan</creatorcontrib><creatorcontrib>Schiessl, Stephan</creatorcontrib><creatorcontrib>Greif, Martin</creatorcontrib><creatorcontrib>Helbig, Susanne</creatorcontrib><creatorcontrib>Tittus, Janine</creatorcontrib><creatorcontrib>Becker, Christoph</creatorcontrib><creatorcontrib>Becker, Alexander</creatorcontrib><title>Use of multi-slice computed tomography in patients with chest-pain submitted to the emergency department</title><title>International Journal of Cardiovascular Imaging</title><addtitle>Int J Cardiovasc Imaging</addtitle><addtitle>Int J Cardiovasc Imaging</addtitle><description>This study evaluates calcium scoring (CS) and computed tomography angiography (MSCTA) in patients >50 years with chest-pain submitted to the emergency department utilising CS as a “diagnostic filter” upfront. Results of CS and MSCTA performed by a 64-slice CT scanner were compared to invasive coronary angiography (ICA). 289 consecutive symptomatic patients (185 men, mean age 71.3 ± 6.4 years) were included. In patients with CS = 0 (Group I; n = 60) or CS > 400 (Group III; n = 95) we refrained from MSCTA, whereas patients with CS 1–400 (Group II; n = 134) underwent subsequent MSCTA. ICA detected significant coronary artery disease (CAD) in 162 patients (56.1 %; male 98). None of Group I-patients showed CAD, but in Group III CAD prevalence increased to 82.1 %. In Group II, MSCTA correctly identified 177/190 significantly diseased vessel segments. Compared to CS alone, our approach increased sensitivity to 98.1 % (+1.8 %), specificity to 82.6 % (+27.5 %) and negative predictive value (NPV) to 97.2 % (+5.1 %) as well as positive predictive value to 87.8 % (+14.6 %), respectively. Overall DA was 91.3 %. Stratification of symptomatic patients into three different risk groups according to CS results with concomitantly increasing disease prevalence is possible. Zero calcium was found to exclude significant CAD, but needs further evaluation. Still server calcifications impair image quality in MSCTA. Thus direct referral to ICA might be a reasonable approach in case of high CS. In patients with intermediate CS, MSCTA is able to rule out significant CAD with a high NPV.</description><subject>Aged</subject><subject>Angina Pectoris - diagnostic imaging</subject><subject>Angina Pectoris - epidemiology</subject><subject>Cardiac Imaging</subject><subject>Cardiology</subject><subject>Cardiology Service, Hospital - utilization</subject><subject>Coronary Angiography - methods</subject><subject>Coronary Angiography - utilization</subject><subject>Coronary Artery Disease - diagnostic imaging</subject><subject>Coronary Artery Disease - epidemiology</subject><subject>Cross-Sectional Studies</subject><subject>Emergency Service, Hospital - utilization</subject><subject>Female</subject><subject>Germany</subject><subject>Humans</subject><subject>Imaging</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Multidetector Computed Tomography - utilization</subject><subject>Original Paper</subject><subject>Predictive Value of Tests</subject><subject>Prevalence</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Radiology</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Severity of Illness Index</subject><subject>Vascular Calcification - diagnostic imaging</subject><subject>Vascular Calcification - epidemiology</subject><issn>1569-5794</issn><issn>1573-0743</issn><issn>1875-8312</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqFkctqHDEQRUWI8fsDsgmCbLKRXXpNt5bBOLbB4I1nLdSa6uk2_YqkJszfW-OemBAIXkmizr1VpUvIFw5XHKC4jhy0Vgy4ZCCMYOYTOeW6yK9Cyc_7-8owXRh1Qs5ifAEAAUIekxOhQGaFPiXNOiIda9rPXWpZ7FqP1I_9NCfc0DT24za4qdnRdqCTSy0OKdLfbWqobzAmNrlciHPVt2kR0NQgxR7DFge_oxucXEh9ll2Qo9p1ES8P5zlZ_7x9vrlnj093Dzc_HplXoBOTla_LPF7hhdelERXqVYUK_AZrEE47sapWDmqjvdHOFCpvV3pVQg2m0MbJc_J98Z3C-GvOM9q-jR67zg04ztFyrRRAqSX_GFVGFEIqoTL67R_0ZZzDkBd5owSXHEym-EL5MMYYsLZTaHsXdpaD3Sdml8RsTszuE7N7zdeDc_5F3Lwr_kSUAbEAMZeGLYa_Wv_X9RWngaCc</recordid><startdate>2014</startdate><enddate>2014</enddate><creator>von Ziegler, Franz</creator><creator>Schenzle, Jan</creator><creator>Schiessl, Stephan</creator><creator>Greif, Martin</creator><creator>Helbig, Susanne</creator><creator>Tittus, Janine</creator><creator>Becker, Christoph</creator><creator>Becker, Alexander</creator><general>Springer Netherlands</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>7QO</scope></search><sort><creationdate>2014</creationdate><title>Use of multi-slice computed tomography in patients with chest-pain submitted to the emergency department</title><author>von Ziegler, Franz ; 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Results of CS and MSCTA performed by a 64-slice CT scanner were compared to invasive coronary angiography (ICA). 289 consecutive symptomatic patients (185 men, mean age 71.3 ± 6.4 years) were included. In patients with CS = 0 (Group I; n = 60) or CS > 400 (Group III; n = 95) we refrained from MSCTA, whereas patients with CS 1–400 (Group II; n = 134) underwent subsequent MSCTA. ICA detected significant coronary artery disease (CAD) in 162 patients (56.1 %; male 98). None of Group I-patients showed CAD, but in Group III CAD prevalence increased to 82.1 %. In Group II, MSCTA correctly identified 177/190 significantly diseased vessel segments. Compared to CS alone, our approach increased sensitivity to 98.1 % (+1.8 %), specificity to 82.6 % (+27.5 %) and negative predictive value (NPV) to 97.2 % (+5.1 %) as well as positive predictive value to 87.8 % (+14.6 %), respectively. Overall DA was 91.3 %. Stratification of symptomatic patients into three different risk groups according to CS results with concomitantly increasing disease prevalence is possible. Zero calcium was found to exclude significant CAD, but needs further evaluation. Still server calcifications impair image quality in MSCTA. Thus direct referral to ICA might be a reasonable approach in case of high CS. In patients with intermediate CS, MSCTA is able to rule out significant CAD with a high NPV.</abstract><cop>Dordrecht</cop><pub>Springer Netherlands</pub><pmid>24030295</pmid><doi>10.1007/s10554-013-0292-9</doi><tpages>9</tpages></addata></record> |
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| subjects | Aged Angina Pectoris - diagnostic imaging Angina Pectoris - epidemiology Cardiac Imaging Cardiology Cardiology Service, Hospital - utilization Coronary Angiography - methods Coronary Angiography - utilization Coronary Artery Disease - diagnostic imaging Coronary Artery Disease - epidemiology Cross-Sectional Studies Emergency Service, Hospital - utilization Female Germany Humans Imaging Male Medicine Medicine & Public Health Middle Aged Multidetector Computed Tomography - utilization Original Paper Predictive Value of Tests Prevalence Prognosis Prospective Studies Radiology Risk Assessment Risk Factors Severity of Illness Index Vascular Calcification - diagnostic imaging Vascular Calcification - epidemiology |
| title | Use of multi-slice computed tomography in patients with chest-pain submitted to the emergency department |
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