American Journal of Cardiology
Volume 106, Issue 4 , Pages 463-469 , 15 August 2010

Usefulness of Computed Tomographic Coronary Angiography in Patients With Acute Chest Pain With and Without High-Risk Features

  • Benjamin J.W. Chow, MD

      Affiliations

    • Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
    • Department of Radiology, University of Ottawa and Ottawa Hospital, Ottawa, Ontario, Canada
    • Corresponding Author InformationCorresponding author: Tel: (613) 761-4044; fax: (613) 761-4929
  • ,
  • Phil Joseph, MD

      Affiliations

    • Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
  • ,
  • Yeung Yam, BSc

      Affiliations

    • Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
  • ,
  • Malek Kass, MD

      Affiliations

    • Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
  • ,
  • Li Chen, MSc

      Affiliations

    • Cardiovascular Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
  • ,
  • Rob S. Beanlands, MD

      Affiliations

    • Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
    • Department of Radiology, University of Ottawa and Ottawa Hospital, Ottawa, Ontario, Canada
  • ,
  • Terrence D. Ruddy, MD

      Affiliations

    • Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
    • Department of Radiology, University of Ottawa and Ottawa Hospital, Ottawa, Ontario, Canada

Received 8 January 2010 ,Revised 25 March 2010 ,Accepted 25 March 2010.

References 

  1. Hamon M, Biondi-Zoccai GGL, 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
  2. 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 Imag C. 2009;2:16–23
  3. Chow BJ, Hoffmann U, Nieman K. Computed tomographic coronary angiography: an alternative to invasive coronary angiography. Can J Cardiol. 2005;21:933–940
  4. Gallagher MJ, Ross MA, Raff GL, Goldstein JA, O'Neill WW, O'Neil B. The diagnostic accuracy of 64-slice computed tomography coronary angiography compared with stress nuclear imaging in emergency department low-risk chest pain patients. Ann Emerg Med. 2007;49:125–136
  5. 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
  6. Hoffmann U, Nagurney JT, Moselewski F, Pena A, Ferencik M, Chae CU, et al. Coronary multidetector computed tomography in the assessment of patients with acute chest pain. Circulation. 2006;114:2251–2260
  7. 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
  8. Meijboom WB, Mollet NR, Van Mieghem CA, Weustink AC, Pugliese F, van Pelt N, et al. 64-Slice CT coronary angiography in patients with non-ST elevation acute coronary syndrome. Heart. 2007;93:1386–1392
  9. Rubinshtein R, Halon DA, Gaspar T, Jaffe R, Karkabi B, Flugelman MY, et al. Usefulness of 64-slice cardiac computed tomographic angiography for diagnosing acute coronary syndromes and predicting clinical outcome in emergency department patients with chest pain of uncertain origin. Circulation. 2007;115:1762–1768
  10. Rubinshtein R, Halon D, Gaspar T, Jaffe R, Goldstein J, Karkabi B, et al. Impact of 64-slice cardiac computed tomographic angiography on clinical decision-making in emergency department patients with chest pain of possible myocardial ischemic origin. Am J Cardiol. 2007;100:1522–1526
  11. Chow BJW, Wells GA, Chen L, Yam Y, Galiwango P, Abraham A, et al. Prognostic value of 64-slice cardiac computed tomography: severity of coronary artery disease, coronary atherosclerosis and left ventricular ejection fraction. J Am Coll Cardiol. 2010;55:1017–1028
  12. Cannon CP, Weintraub WS, Demopoulos LA, Vicari R, Frey MJ, Lakkis N, et al. Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban. N Engl J Med. 2001;344:1879–1887
  13. Smith SC, Dove JT, Jacobs AK, Kennedy J, Kereiakes D, Kern MJ, et al. ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines)—executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty) endorsed by the Society for Cardiac Angiography and Interventions. J Am Coll Cardiol. 2001;37:2215–2238
  14. Braunwald E, Antman EM, Beasley JW, Califf RM, Cheitlin MD, Hochman JS, et al. ACC/AHA guidelines for the management of patients with unstable angina and non-ST segment elevation myocardial infarction: Executive summary and recommendations: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the management of patients with unstable angina). Circulation. 2000;102:1193–1209
  15. Bertrand ME, Simoons ML, Fox KAA, Wallentin LC, Hamm CW, McFadden E, et al. Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2002;23:1809–1840
  16. The IMPACT-II Investigators. Randomised placebo-controlled trial of effect of eptifibatide on complications of percutaneous coronary intervention: IMPACT-II. Lancet. 1997;349:1422–1428
  17. The PURSUIT Trial Investigators. Inhibition of platelet glycoprotein IIb/IIIa with eptifibatide in patients with acute coronary syndromes. N Engl J Med. 1998;339:436–443
  18. Platelet Receptor Inhibition in Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms (PRISM-PLUS) Study Investigators. Inhibition of the platelet glycoprotein IIb/IIIa receptor with tirofiban in unstable angina and non-Q-wave myocardial infarction. N Engl J Med. 1998;338:1488–1497
  19. de Winter RJ, Windhausen F, Cornel JH, Dunselman PHJM, Janus CL, Bendermacher PEF, et al. Early invasive versus selectively invasive management for acute coronary syndromes. N Engl J Med. 2005;353:1095–1104

 Dr. Chow is supported by the Canadian Institutes of Health Research New Investigator Award No. MSH-83718. This study was supported in part by the Ontario Research Fund, Ontario, Canada, Imaging for Cardiovascular Therapeutics Project No. RE02-038, Ontario, Canada, the Canada Foundation for Innovation No. 11966, Canada, and by an investigator initiated research grant from GE Healthcare (Princeton, New Jersey).

PII: S0002-9149(10)00842-8

doi: 10.1016/j.amjcard.2010.03.058

American Journal of Cardiology
Volume 106, Issue 4 , Pages 463-469 , 15 August 2010