Coronary Computed Tomography Angiography for Early Triage of Patients With Acute Chest Pain: The ROMICAT (Rule Out Myocardial Infarction using Computer Assisted Tomography) Trial
This study was designed to determine the usefulness of coronary computed tomography angiography (CTA) in patients with acute chest pain. Triage of chest pain patients in the emergency department remains challenging. We used an observational cohort study in chest pain patients with normal initial tro...
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| Veröffentlicht in: | Journal of the American College of Cardiology 2009-05, Vol.53 (18), p.1642-1650 |
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| creator | HOFFMANN, Udo BAMBERG, Fabian MOLOO, Jamaluddin BUTLER, Javed FERENCIK, Maros LEE, Hang JANG, Ik-Kyung PARRY, Blair A BROWN, David F UDELSON, James E ACHENBACH, Stephan BRADY, Thomas J CHAE, Claudia U NAGURNEY, John T NICHOLS, John H ROGERS, Ian S SENEVIRATNE, Sujith K TRUONG, Quynh A CURY, Ricardo C ABBARA, Suhny SHAPIRO, Michael D |
| description | This study was designed to determine the usefulness of coronary computed tomography angiography (CTA) in patients with acute chest pain.
Triage of chest pain patients in the emergency department remains challenging.
We used an observational cohort study in chest pain patients with normal initial troponin and nonischemic electrocardiogram. A 64-slice coronary CTA was performed before admission to detect coronary plaque and stenosis (>50% luminal narrowing). Results were not disclosed. End points were acute coronary syndrome (ACS) during index hospitalization and major adverse cardiac events during 6-month follow-up.
Among 368 patients (mean age 53 +/- 12 years, 61% men), 31 had ACS (8%). By coronary CTA, 50% of these patients were free of coronary artery disease (CAD), 31% had nonobstructive disease, and 19% had inconclusive or positive computed tomography for significant stenosis. Sensitivity and negative predictive value for ACS were 100% (n = 183 of 368; 95% confidence interval [CI]: 98% to 100%) and 100% (95% CI: 89% to 100%), respectively, with the absence of CAD and 77% (95% CI: 59% to 90%) and 98% (n = 300 of 368, 95% CI: 95% to 99%), respectively, with significant stenosis by coronary CTA. Specificity of presence of plaque and stenosis for ACS were 54% (95% CI: 49% to 60%) and 87% (95% CI: 83% to 90%), respectively. Only 1 ACS occurred in the absence of calcified plaque. Both the extent of coronary plaque and presence of stenosis predicted ACS independently and incrementally to Thrombolysis In Myocardial Infarction risk score (area under curve: 0.88, 0.82, vs. 0.63, respectively; all p < 0.0001).
Fifty percent of patients with acute chest pain and low to intermediate likelihood of ACS were free of CAD by computed tomography and had no ACS. Given the large number of such patients, early coronary CTA may significantly improve patient management in the emergency department. |
| doi_str_mv | 10.1016/j.jacc.2009.01.052 |
| format | Article |
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Triage of chest pain patients in the emergency department remains challenging.
We used an observational cohort study in chest pain patients with normal initial troponin and nonischemic electrocardiogram. A 64-slice coronary CTA was performed before admission to detect coronary plaque and stenosis (>50% luminal narrowing). Results were not disclosed. End points were acute coronary syndrome (ACS) during index hospitalization and major adverse cardiac events during 6-month follow-up.
Among 368 patients (mean age 53 +/- 12 years, 61% men), 31 had ACS (8%). By coronary CTA, 50% of these patients were free of coronary artery disease (CAD), 31% had nonobstructive disease, and 19% had inconclusive or positive computed tomography for significant stenosis. Sensitivity and negative predictive value for ACS were 100% (n = 183 of 368; 95% confidence interval [CI]: 98% to 100%) and 100% (95% CI: 89% to 100%), respectively, with the absence of CAD and 77% (95% CI: 59% to 90%) and 98% (n = 300 of 368, 95% CI: 95% to 99%), respectively, with significant stenosis by coronary CTA. Specificity of presence of plaque and stenosis for ACS were 54% (95% CI: 49% to 60%) and 87% (95% CI: 83% to 90%), respectively. Only 1 ACS occurred in the absence of calcified plaque. Both the extent of coronary plaque and presence of stenosis predicted ACS independently and incrementally to Thrombolysis In Myocardial Infarction risk score (area under curve: 0.88, 0.82, vs. 0.63, respectively; all p < 0.0001).
Fifty percent of patients with acute chest pain and low to intermediate likelihood of ACS were free of CAD by computed tomography and had no ACS. Given the large number of such patients, early coronary CTA may significantly improve patient management in the emergency department.</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/j.jacc.2009.01.052</identifier><identifier>PMID: 19406338</identifier><identifier>CODEN: JACCDI</identifier><language>eng</language><publisher>New York, NY: Elsevier</publisher><subject>Acute Coronary Syndrome - diagnosis ; Acute Coronary Syndrome - physiopathology ; Acute Disease ; Angina pectoris ; Biological and medical sciences ; California ; Cardiology ; Cardiology. Vascular system ; Cardiovascular system ; Chest Pain - diagnosis ; Chest Pain - physiopathology ; Confidence Intervals ; Coronary Angiography - methods ; Coronary heart disease ; Coronary vessels ; Diagnosis, Differential ; Emergency Service, Hospital - statistics & numerical data ; Female ; Heart ; Heart attacks ; Hospitalization ; Humans ; Investigative techniques, diagnostic techniques (general aspects) ; Male ; Medical imaging ; Medical sciences ; Middle Aged ; Myocarditis. Cardiomyopathies ; Odds Ratio ; Prospective Studies ; Radiodiagnosis. Nmr imagery. Nmr spectrometry ; Risk Factors ; ROC Curve ; Sensitivity and Specificity ; Single-Blind Method ; Time Factors ; Tomography, X-Ray Computed ; Triage - statistics & numerical data</subject><ispartof>Journal of the American College of Cardiology, 2009-05, Vol.53 (18), p.1642-1650</ispartof><rights>2009 INIST-CNRS</rights><rights>Copyright Elsevier Limited May 5, 2009</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,782,786,27933,27934</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21487179$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19406338$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>HOFFMANN, Udo</creatorcontrib><creatorcontrib>BAMBERG, Fabian</creatorcontrib><creatorcontrib>MOLOO, Jamaluddin</creatorcontrib><creatorcontrib>BUTLER, Javed</creatorcontrib><creatorcontrib>FERENCIK, Maros</creatorcontrib><creatorcontrib>LEE, Hang</creatorcontrib><creatorcontrib>JANG, Ik-Kyung</creatorcontrib><creatorcontrib>PARRY, Blair A</creatorcontrib><creatorcontrib>BROWN, David F</creatorcontrib><creatorcontrib>UDELSON, James E</creatorcontrib><creatorcontrib>ACHENBACH, Stephan</creatorcontrib><creatorcontrib>BRADY, Thomas J</creatorcontrib><creatorcontrib>CHAE, Claudia U</creatorcontrib><creatorcontrib>NAGURNEY, John T</creatorcontrib><creatorcontrib>NICHOLS, John H</creatorcontrib><creatorcontrib>ROGERS, Ian S</creatorcontrib><creatorcontrib>SENEVIRATNE, Sujith K</creatorcontrib><creatorcontrib>TRUONG, Quynh A</creatorcontrib><creatorcontrib>CURY, Ricardo C</creatorcontrib><creatorcontrib>ABBARA, Suhny</creatorcontrib><creatorcontrib>SHAPIRO, Michael D</creatorcontrib><title>Coronary Computed Tomography Angiography for Early Triage of Patients With Acute Chest Pain: The ROMICAT (Rule Out Myocardial Infarction using Computer Assisted Tomography) Trial</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>This study was designed to determine the usefulness of coronary computed tomography angiography (CTA) in patients with acute chest pain.
Triage of chest pain patients in the emergency department remains challenging.
We used an observational cohort study in chest pain patients with normal initial troponin and nonischemic electrocardiogram. A 64-slice coronary CTA was performed before admission to detect coronary plaque and stenosis (>50% luminal narrowing). Results were not disclosed. End points were acute coronary syndrome (ACS) during index hospitalization and major adverse cardiac events during 6-month follow-up.
Among 368 patients (mean age 53 +/- 12 years, 61% men), 31 had ACS (8%). By coronary CTA, 50% of these patients were free of coronary artery disease (CAD), 31% had nonobstructive disease, and 19% had inconclusive or positive computed tomography for significant stenosis. Sensitivity and negative predictive value for ACS were 100% (n = 183 of 368; 95% confidence interval [CI]: 98% to 100%) and 100% (95% CI: 89% to 100%), respectively, with the absence of CAD and 77% (95% CI: 59% to 90%) and 98% (n = 300 of 368, 95% CI: 95% to 99%), respectively, with significant stenosis by coronary CTA. Specificity of presence of plaque and stenosis for ACS were 54% (95% CI: 49% to 60%) and 87% (95% CI: 83% to 90%), respectively. Only 1 ACS occurred in the absence of calcified plaque. Both the extent of coronary plaque and presence of stenosis predicted ACS independently and incrementally to Thrombolysis In Myocardial Infarction risk score (area under curve: 0.88, 0.82, vs. 0.63, respectively; all p < 0.0001).
Fifty percent of patients with acute chest pain and low to intermediate likelihood of ACS were free of CAD by computed tomography and had no ACS. Given the large number of such patients, early coronary CTA may significantly improve patient management in the emergency department.</description><subject>Acute Coronary Syndrome - diagnosis</subject><subject>Acute Coronary Syndrome - physiopathology</subject><subject>Acute Disease</subject><subject>Angina pectoris</subject><subject>Biological and medical sciences</subject><subject>California</subject><subject>Cardiology</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular system</subject><subject>Chest Pain - diagnosis</subject><subject>Chest Pain - physiopathology</subject><subject>Confidence Intervals</subject><subject>Coronary Angiography - methods</subject><subject>Coronary heart disease</subject><subject>Coronary vessels</subject><subject>Diagnosis, Differential</subject><subject>Emergency Service, Hospital - statistics & numerical data</subject><subject>Female</subject><subject>Heart</subject><subject>Heart attacks</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Myocarditis. Cardiomyopathies</subject><subject>Odds Ratio</subject><subject>Prospective Studies</subject><subject>Radiodiagnosis. Nmr imagery. Nmr spectrometry</subject><subject>Risk Factors</subject><subject>ROC Curve</subject><subject>Sensitivity and Specificity</subject><subject>Single-Blind Method</subject><subject>Time Factors</subject><subject>Tomography, X-Ray Computed</subject><subject>Triage - statistics & numerical data</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkcFu1DAQhi0EotvCC3BAlhAIDgl2HNsJt1VUoFKrRVUQx2ji2BuvsvbWTg77WjxhDewiwWlGmm_m_2cGoVeU5JRQ8XGX70CpvCCkzgnNCS-eoBXlvMoYr-VTtCKS8YySWl6gyxh3hBBR0fo5uqB1SQRj1Qr9bHzwDsIRN35_WGY94Nbv_TbAYTzitdvac258wNcQpiNug4Wtxt7gbzBb7eaIf9h5xGuV-nEz6jininWfcDtqfL-5u2nWLX5_v0wab5YZ3x29gjBYmPCNMxDUbL3DS7Rue3YR8DpGG_-18-G38vQCPTMwRf3yFK_Q98_XbfM1u918SUq32cgImzMqRdUXhpi-h4JxTgfNSFlxpgsQvZScMSEqwSWofqAlUNODUYYKUpOamYpdoXd_5h6Cf1jSUt3eRqWnCZz2S-yELBJYlAl88x-480twyVtHORFF-UsrUa9P1NLv9dAdgt2nu3fnXyTg7QmAqGAyAZyy8S9X0LKSVNbsEebTmmE</recordid><startdate>20090505</startdate><enddate>20090505</enddate><creator>HOFFMANN, Udo</creator><creator>BAMBERG, Fabian</creator><creator>MOLOO, Jamaluddin</creator><creator>BUTLER, Javed</creator><creator>FERENCIK, Maros</creator><creator>LEE, Hang</creator><creator>JANG, Ik-Kyung</creator><creator>PARRY, Blair A</creator><creator>BROWN, David F</creator><creator>UDELSON, James E</creator><creator>ACHENBACH, Stephan</creator><creator>BRADY, Thomas J</creator><creator>CHAE, Claudia U</creator><creator>NAGURNEY, John T</creator><creator>NICHOLS, John H</creator><creator>ROGERS, Ian S</creator><creator>SENEVIRATNE, Sujith K</creator><creator>TRUONG, Quynh A</creator><creator>CURY, Ricardo C</creator><creator>ABBARA, Suhny</creator><creator>SHAPIRO, Michael D</creator><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20090505</creationdate><title>Coronary Computed Tomography Angiography for Early Triage of Patients With Acute Chest Pain: The ROMICAT (Rule Out Myocardial Infarction using Computer Assisted Tomography) Trial</title><author>HOFFMANN, Udo ; BAMBERG, Fabian ; MOLOO, Jamaluddin ; BUTLER, Javed ; FERENCIK, Maros ; LEE, Hang ; JANG, Ik-Kyung ; PARRY, Blair A ; BROWN, David F ; UDELSON, James E ; ACHENBACH, Stephan ; BRADY, Thomas J ; CHAE, Claudia U ; NAGURNEY, John T ; NICHOLS, John H ; ROGERS, Ian S ; SENEVIRATNE, Sujith K ; TRUONG, Quynh A ; CURY, Ricardo C ; ABBARA, Suhny ; SHAPIRO, Michael D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-h303t-1768b2f0fbba23551de304853e2a6b77533668657acbd14a1fbafcf1609093f83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Acute Coronary Syndrome - diagnosis</topic><topic>Acute Coronary Syndrome - physiopathology</topic><topic>Acute Disease</topic><topic>Angina pectoris</topic><topic>Biological and medical sciences</topic><topic>California</topic><topic>Cardiology</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular system</topic><topic>Chest Pain - diagnosis</topic><topic>Chest Pain - physiopathology</topic><topic>Confidence Intervals</topic><topic>Coronary Angiography - methods</topic><topic>Coronary heart disease</topic><topic>Coronary vessels</topic><topic>Diagnosis, Differential</topic><topic>Emergency Service, Hospital - statistics & numerical data</topic><topic>Female</topic><topic>Heart</topic><topic>Heart attacks</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Myocarditis. Cardiomyopathies</topic><topic>Odds Ratio</topic><topic>Prospective Studies</topic><topic>Radiodiagnosis. Nmr imagery. Nmr spectrometry</topic><topic>Risk Factors</topic><topic>ROC Curve</topic><topic>Sensitivity and Specificity</topic><topic>Single-Blind Method</topic><topic>Time Factors</topic><topic>Tomography, X-Ray Computed</topic><topic>Triage - statistics & numerical data</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>HOFFMANN, Udo</creatorcontrib><creatorcontrib>BAMBERG, Fabian</creatorcontrib><creatorcontrib>MOLOO, Jamaluddin</creatorcontrib><creatorcontrib>BUTLER, Javed</creatorcontrib><creatorcontrib>FERENCIK, Maros</creatorcontrib><creatorcontrib>LEE, Hang</creatorcontrib><creatorcontrib>JANG, Ik-Kyung</creatorcontrib><creatorcontrib>PARRY, Blair A</creatorcontrib><creatorcontrib>BROWN, David F</creatorcontrib><creatorcontrib>UDELSON, James E</creatorcontrib><creatorcontrib>ACHENBACH, Stephan</creatorcontrib><creatorcontrib>BRADY, Thomas J</creatorcontrib><creatorcontrib>CHAE, Claudia U</creatorcontrib><creatorcontrib>NAGURNEY, John T</creatorcontrib><creatorcontrib>NICHOLS, John H</creatorcontrib><creatorcontrib>ROGERS, Ian S</creatorcontrib><creatorcontrib>SENEVIRATNE, Sujith K</creatorcontrib><creatorcontrib>TRUONG, Quynh A</creatorcontrib><creatorcontrib>CURY, Ricardo C</creatorcontrib><creatorcontrib>ABBARA, Suhny</creatorcontrib><creatorcontrib>SHAPIRO, Michael D</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>HOFFMANN, Udo</au><au>BAMBERG, Fabian</au><au>MOLOO, Jamaluddin</au><au>BUTLER, Javed</au><au>FERENCIK, Maros</au><au>LEE, Hang</au><au>JANG, Ik-Kyung</au><au>PARRY, Blair A</au><au>BROWN, David F</au><au>UDELSON, James E</au><au>ACHENBACH, Stephan</au><au>BRADY, Thomas J</au><au>CHAE, Claudia U</au><au>NAGURNEY, John T</au><au>NICHOLS, John H</au><au>ROGERS, Ian S</au><au>SENEVIRATNE, Sujith K</au><au>TRUONG, Quynh A</au><au>CURY, Ricardo C</au><au>ABBARA, Suhny</au><au>SHAPIRO, Michael D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Coronary Computed Tomography Angiography for Early Triage of Patients With Acute Chest Pain: The ROMICAT (Rule Out Myocardial Infarction using Computer Assisted Tomography) Trial</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>2009-05-05</date><risdate>2009</risdate><volume>53</volume><issue>18</issue><spage>1642</spage><epage>1650</epage><pages>1642-1650</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><coden>JACCDI</coden><abstract>This study was designed to determine the usefulness of coronary computed tomography angiography (CTA) in patients with acute chest pain.
Triage of chest pain patients in the emergency department remains challenging.
We used an observational cohort study in chest pain patients with normal initial troponin and nonischemic electrocardiogram. A 64-slice coronary CTA was performed before admission to detect coronary plaque and stenosis (>50% luminal narrowing). Results were not disclosed. End points were acute coronary syndrome (ACS) during index hospitalization and major adverse cardiac events during 6-month follow-up.
Among 368 patients (mean age 53 +/- 12 years, 61% men), 31 had ACS (8%). By coronary CTA, 50% of these patients were free of coronary artery disease (CAD), 31% had nonobstructive disease, and 19% had inconclusive or positive computed tomography for significant stenosis. Sensitivity and negative predictive value for ACS were 100% (n = 183 of 368; 95% confidence interval [CI]: 98% to 100%) and 100% (95% CI: 89% to 100%), respectively, with the absence of CAD and 77% (95% CI: 59% to 90%) and 98% (n = 300 of 368, 95% CI: 95% to 99%), respectively, with significant stenosis by coronary CTA. Specificity of presence of plaque and stenosis for ACS were 54% (95% CI: 49% to 60%) and 87% (95% CI: 83% to 90%), respectively. Only 1 ACS occurred in the absence of calcified plaque. Both the extent of coronary plaque and presence of stenosis predicted ACS independently and incrementally to Thrombolysis In Myocardial Infarction risk score (area under curve: 0.88, 0.82, vs. 0.63, respectively; all p < 0.0001).
Fifty percent of patients with acute chest pain and low to intermediate likelihood of ACS were free of CAD by computed tomography and had no ACS. Given the large number of such patients, early coronary CTA may significantly improve patient management in the emergency department.</abstract><cop>New York, NY</cop><pub>Elsevier</pub><pmid>19406338</pmid><doi>10.1016/j.jacc.2009.01.052</doi><tpages>9</tpages></addata></record> |
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| source | MEDLINE; Access via ScienceDirect (Elsevier); EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Acute Coronary Syndrome - diagnosis Acute Coronary Syndrome - physiopathology Acute Disease Angina pectoris Biological and medical sciences California Cardiology Cardiology. Vascular system Cardiovascular system Chest Pain - diagnosis Chest Pain - physiopathology Confidence Intervals Coronary Angiography - methods Coronary heart disease Coronary vessels Diagnosis, Differential Emergency Service, Hospital - statistics & numerical data Female Heart Heart attacks Hospitalization Humans Investigative techniques, diagnostic techniques (general aspects) Male Medical imaging Medical sciences Middle Aged Myocarditis. Cardiomyopathies Odds Ratio Prospective Studies Radiodiagnosis. Nmr imagery. Nmr spectrometry Risk Factors ROC Curve Sensitivity and Specificity Single-Blind Method Time Factors Tomography, X-Ray Computed Triage - statistics & numerical data |
| title | Coronary Computed Tomography Angiography for Early Triage of Patients With Acute Chest Pain: The ROMICAT (Rule Out Myocardial Infarction using Computer Assisted Tomography) Trial |
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