Heart, Lung and Circulation
Volume 19, Issue 4 , Pages 213-218 , April 2010

The Value of Dual-source 64-Slice CT Coronary Angiography in the Assessment of Patients Presenting to an Acute Chest Pain Service

  • Mark Hansen, FRANZCR

      Affiliations

    • Department of Radiology, Prince Charles Hospital, Brisbane, Australia
    • ,
  • Jonathan Ginns, FRACP

      Affiliations

    • Department of Cardiology, Prince Charles Hospital, Rode Road, Chermside, Brisbane 4032, Queensland, Australia
    • ,
  • Sujith Seneviratne, FRACP, FCSANZ

      Affiliations

    • Department of Cardiology, Prince Charles Hospital, Rode Road, Chermside, Brisbane 4032, Queensland, Australia
    • ,
  • Richard Slaughter, FRANZCR

      Affiliations

    • Department of Radiology, Prince Charles Hospital, Brisbane, Australia
    • ,
  • Manuja Premaranthe, MB BS

      Affiliations

    • Department of Cardiology, Prince Charles Hospital, Rode Road, Chermside, Brisbane 4032, Queensland, Australia
    • ,
  • Himabindu Samardhi, MB BS

      Affiliations

    • Department of Cardiology, Prince Charles Hospital, Rode Road, Chermside, Brisbane 4032, Queensland, Australia
    • ,
  • Jodi Harker, FRACP

      Affiliations

    • Department of Cardiology, Prince Charles Hospital, Rode Road, Chermside, Brisbane 4032, Queensland, Australia
    • ,
  • Tony Lai, MB BS

      Affiliations

    • Department of Cardiology, Prince Charles Hospital, Rode Road, Chermside, Brisbane 4032, Queensland, Australia
    • ,
  • Darren L. Walters, FRACP, FCSANZ

      Affiliations

    • Department of Cardiology, Prince Charles Hospital, Rode Road, Chermside, Brisbane 4032, Queensland, Australia
    • ,
  • Nicholas Bett, FRACP, FCSANZ, DDU

      Affiliations

    • Department of Cardiology, Prince Charles Hospital, Rode Road, Chermside, Brisbane 4032, Queensland, Australia
    • Corresponding Author InformationCorresponding author. Tel.: +61 7 3139 4565.

Received 10 October 2009 ,Revised 23 December 2009 ,Accepted 4 January 2010.

References 

  1. Budoff MJ, Dowe D, Jollis JG, Gitter M, SutherlandJ , Halamert E, et al. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (assessment by coronary computed tomographic angiography of individuals undergoing invasive coronary angiography) trial. J Am Coll Cardiol. 2008;52:1724–1732
  2. Hamon M, Biondi-Zoccai GG, Malagutti P, Agostoni P, Morello R, Valgimigli M, et al. Diagnostic performance of multislice spiral computed tomography of coronary arteries as compared with conventional invasive coronary angiography: a meta-analysis. J Am Coll Cardiol. 2006;48:1896–1910
  3. Goldstein JA, Gallagher MJ, O’Neill WW, Ross MA, O’Neil BJ, Raff GL. A randomized controlled trial of multi-slice coronary computed tomography for evaluation of acute chest pain. J Am Coll Cardiol. 2007;49:863–871
  4. Chow BJW, Abraham A, Wells GA, Chen L, Ruddy TD, Yam Y, et al. Diagnostic accuracy and impact of computed tomographic coronary angiography on utilization of invasive coronary angiography. Circ Cardiovasc Imaging. 2009;2:16–23
  5. Min JK, Shaw LJ, Devereux RB, Okin PM, Weinsaft JW, Russo DJ, et al. Prognostic value of multidetector coronary computed tomographic angiography for prediction of all-cause mortality. J Am Coll Cardiol. 2007;50:1161–1170
  6. Hoffmann U, Bamberg F, Chae CU, Nichols JH, Rogers IS, Seneviratne SK, et al. Coronary computed tomography angiography for early triage of patients with acute chest pain: the ROMICAT (rule out myocardial infarction using computer assisted tomography) trial. J Am Coll Cardiol. 2009;53:1642–1650
  7. Hausleiter J, Meyer T, Hadamitzky M, Zankl M, Gerein P, Dorrler K, et al. Non-invasive coronary computed tomographic angiography for patients with suspected coronary artery disease: the coronary angiography by computed tomography with the use of a submillimeter resolution (CACTUS) trial. Eur Heart J. 2007;28:3034–3041
  8. Kitagawa T, Yamamoto H, Horiguchi J, Ohhashi N, Tadehara F, Shokawa T, et al. Characterization of noncalcified coronary plaques and identification of culprit lesions in patients with acute coronary syndrome by 64-slice computed tomography. J Am Coll Cardiol Img. 2009;2:153–160
  9. Lehman SJ, Abbara S, Cury RC, Nagurney JT, Hsu J, Goela A, et al. Significance of cardiac computed tomography incidental findings in acute chest pain. Am J Med. 2009;122:543–549
  10. Hadamitzky M, Freissmuth B, Meyer T, Hein F, Kastrati A, Martinoff S, et al. Prognostic value of coronary computed tomographic angiography for prediction of cardiac events in patients with suspected coronary artery disease. J Am Coll Cardiol Img. 2009;2:404–411
  11. Achenbach S, Ropers U, Kuettner A, Anders K, Pflederer T, Komatsu S, et al. Randomized comparison of 64-slice single- and dual-source computed tomography coronary angiography for the detection of coronary artery disease. J Am Coll Cardiol Img. 2008;1:177–186
  12. Aroney CN, Dunlevie HL, Bett JHN. Use of an accelerated chest pain assessment protocol in patients at intermediate risk of adverse cardiac events. Med J Aust. 2003;178:370–374
  13. Gibbons RJ, Balady GJ, Beasley JW, Bricker JT, Duvernoy WF, Froelicher VF, et al. ACC/AHA guidelines for exercise testing: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). Circulation. 1997;96:345–354
  14. Stowers SA, Eisenstein EL, Th Wackers FJ, Berman DS, Blackshear JL, Jones AD, et al. An economic analysis of an aggressive diagnostic strategy with single photon emission computed tomography myocardial perfusion imaging and early exercise stress testing in emergency department patients who present with chest pain but nondiagnostic electrocardiograms: results from a randomized trial. Ann Emerg Med. 2000;35:17–25
  15. van Werkhoven JM, Schuijf JD, Gaemperli O, Jukema JW, Boersma E, Wijns W, et al. Prognostic value of multislice computed tomography and gated single-photon emission computed tomography in patients with suspected coronary artery disease. J Am Coll Cardiol. 2009;53:623–632
  16. Marwick TH, Case C, Vasey C, Allen S, Short L, Thomas JD. Prediction of mortality by exercise echocardiography: a strategy for combination with the duke treadmill score. Circulation. 2001;103:2566–2571
  17. Marwick TH, Case C, Sawada S, Rimmerman C, Brenneman P, Kovacs R, et al. Prediction of mortality using dobutamine echocardiography. J Am Coll Cardiol. 2001;37:754–760
  18. Mikhail MG, Smith FA, Gray M, Britton C, Frederiksen SM. Cost-effectiveness of mandatory stress testing in chest pain center patients. Ann Emerg Med. 1997;29:88–98
  19. Amsterdam EA, Kirk JD, Diercks DB, Lewis WR, Turnipseed SD. Immediate exercise testing to evaluate low-risk patients presenting to the emergency department with chest pain. J Am Coll Cardiol. 2002;40:251–256
  20. Mark DB, Shaw L, Harrell FE, Hlatky MA, Lee KL, Bengtson JR, et al. Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. New Engl J Med. 1991;325:849–853
  21. Pundziute G, Schuijf JD, Jukema JW, van Werkhoven JM, Boersma E, de Roos A, et al. Gender influence on the diagnostic accuracy of 64-slice multislice computed tomography coronary angiography for detection of obstructive coronary artery disease. Heart. 2008;94:48–52
  22. Hausleiter J, Meyer T, Hadamitzky M, Huber E, Zankl M, Martinoff S, et al. Radiation dose estimates from cardiac multislice computed tomography in daily practice: impact of different scanning protocols on effective dose estimates. Circulation. 2006;113:1305–1310
  23. Roberts RR, Zalenski RJ, Mensah EK, Rydman RJ, Ciavarella G, Gussow L, et al. Costs of an emergency department-based accelerated diagnostic protocol vs. hospitalization in patients with chest pain: a randomized controlled trial [see comments]. JAMA. 1997;278:1670–1676
  24. Storrow AB, Gibler WB. Chest pain centers: diagnosis of acute coronary syndromes. Ann Emerg Med. 2000;35:449–461
  25. Diamond GA, Forrester JS. Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. New Engl J Med. 1979;300:1350–1358
  26. Kreisz FP, Merlin T, Moss J, Atherton J, Hiller JE, Gericke CA. The pre-test risk stratified cost-effectiveness of 64-slice computed tomography coronary angiography in the detection of significant obstructive coronary artery disease in patients otherwise referred to invasive coronary angiography. Heart Lung Circ. 2009;18:200–207
  27. Haberl R, Becker A, Leber A, Knez A, Becker C, Lang C, et al. Correlation of coronary calcification and angiographically documented stenoses in patients with suspected coronary artery disease: results of 1,764 patients. J Am Coll Cardiol. 2001;37:451–457
  28. Broderick LS, Shemesh J, Wilensky RL, Eckert GJ, Zhou X, Torres WE, et al. Measurement of coronary artery calcium with dual-slice helical CT compared with coronary angiography: evaluation of CT scoring methods, interobserver variations, and reproducibility. AJR Am J Roentgenol. 1996;167:439–444
  29. Detrano R, Hsiai T, Wang S, Puentes G, Fallavollita J, Shields P, et al. Prognostic value of coronary calcification and angiographic stenoses in patients undergoing coronary angiography. J Am Coll Cardiol. 1996;27:285–290
  30. Sarwar A, Shaw LJ, Shapiro MD, Blankstein R, Hoffman U, Cury RC, et al. Diagnostic and prognostic value of absence of coronary artery calcification. J Am Coll Cardiol Img. 2009;2:675–688
  31. Lamont DH, Budoff MJ, Shavelle DM, Shavelle R, Brundage BH, Hagar JM. Coronary calcium scanning adds incremental value to patients with positive stress tests. Am Heart J. 2002;143:861–867
  32. Blaha M, Budoff MJ, Shaw LJ, Khosa F, Rumberger JA, Berman D, et al. Absence of coronary artery calcification and all-cause mortality. J Am Coll Cardiol Img. 2009;2:692–700
  33. Gerber TC, Carr JJ, Arai AE, Dixon RL, Ferrari VA, Gomes AS, et al. Ionizing radiation in cardiac imaging: a science advisory from the American Heart Association Committee on Cardiac Imaging of the Council on Clinical Cardiology and Committee on Cardiovascular Imaging and Intervention of the Council on Cardiovascular Radiology and Intervention. Circulation. 2009;119:1056–1065
  34. Kim KP, Einstein AJ, Berrington de Gonzalez A. Coronary artery calcification screening: estimated radiation dose and cancer risk. Arch Intern Med. 2009;169:1188–1194
  35. Herzog BA, Husmann L, Burkhard N, Gaemperli O, Valenta I, Tatsugami F, et al. Accuracy of low-dose computed tomography coronary angiography using prospective electrocardiogram-triggering: first clinical experience. Eur Heart J. 2008;29:3037–3042
  36. Earls JP, Berman EL, Urban BA, Curry CA, Lane JL, Jennings RS, et al. Prospectively gated transverse coronary CT angiography versus retrospectively gated helical technique: improved image quality and reduced radiation dose. Radiology. 2008;246:742–753
  37. Takakuwa KM, Halpern EJ, Gingold EL, Levin DC, Shofer FS. Radiation dose in a “triple rule-out” coronary CT angiography protocol of emergency department patients using 64-MDCT: the impact of ECG-based tube current modulation on age, sex, and body mass index. AJR Am J Roentgenol. 2009;192:866–872
  38. Pflederer T, Rudofsky L, Ropers D, Bachmann S, Marwan M, Daniel WG, et al. Image quality in a low radiation exposure protocol for retrospectively ECG-gated coronary CT angiography. AJR Am J Roentgenol. 2009;192:1045–1050
  39. Bischoff B, Hein F, Meyer T, Hadamitzky M, Martinoff S, Schomig A, et al. Impact of a reduced tube voltage on CT angiography and radiation dose: results of the PROTECTION I study. J Am Coll Cardiol Img. 2009;2:940–946
  40. Pontone G, Andreini D, Bartorelli AL, Cortinovis S, Mushtaq S, Bertella E, et al. Diagnostic accuracy of coronary computed tomography angiography: a comparison between prospective and retrospective electrocardiogram triggering. J Am Coll Cardiol. 2009;54:346–355
  41. Raff GL, Chinnaiyan KM, Share DA, Goraya TY, Kazerooni EA, Moscucci M, et al. Radiation dose from cardiac computed tomography before and after implementation of radiation dose-reduction techniques. JAMA. 2009;301:2340–2348
  42. Shuman WP, Branch KR, May JM, Mitsumori LM, Strote JN, Warren BH, et al. Whole-chest 64-MDCT of emergency department patients with nonspecific chest pain: radiation dose and coronary artery image quality with prospective ECG triggering versus retrospective ECG gating. AJR Am J Roentgenol. 2009;192:1662–1667
  43. Zanzonico P, Rothenberg LN, Strauss HW. Radiation exposure of computed tomography and direct intracoronary angiography: risk has its reward. J Am Coll Cardiol. 2006;47:1846–1849

PII: S1443-9506(10)00006-5

doi: 10.1016/j.hlc.2010.01.004

Heart, Lung and Circulation
Volume 19, Issue 4 , Pages 213-218 , April 2010

Article Tools