Acute left circumflex coronary artery occlusion detected on nongated CT

Diagnostic Accuracy of Coronary Artery Occlusion and Myocardial Perfusion Defect on Non-Gated Enhanced Chest CT in Predicting Acute Myocardial Infarction

The purpose of this study was to evaluate the diagnostic accuracy of coronary artery occlusion (CAO) and myocardial perfusion defect (MPD) identified on non-gated enhanced chest CT in patients with acute myocardial infarction (AMI). We retrospectively assessed 99 patients with AMI (group 1, n = 33) and without AMI (group 2, n = 66) who underwent non-gated chest CT. We analyzed the presence of MPD and CAO on non-gated chest CT. MPD on the CT was categorized using a three-point scale (0 = no definite MPD; 1 = probable artifact or questionable MPD; 2 = probable MPD). Presence of CAO was defined as an abrupt change of contrast enhancement in a coronary artery segment with no or minimal coronary motion on the CT. There were 42.4% and 12.1% patients with probable MPD (p = 0.002), and 18.2% and 0% patients with CAO (p = 0.001) in groups 1 and 2, respectively. Probable MPD alone and simultaneous presence of CAO and probable MPD to predict AMI resulted in sensitivity, specificity, negative predictive value, and positive predictive valve of 42.4%, 87.9%, 75.3%, and 63.6%, respectively, and 12.1%, 100%, 69.5%, and 100%, respectively. In conclusion, probable MPD alone on non-gated chest CT demonstrated a relatively low sensitivity, high specificity, and modest positive predictive value for the prediction of AMI on non-gated enhanced chest CT. Although it is rare, simultaneous presence of CAO and probable MPD had a high positive predictive value to predict AMI on non-gated enhanced chest CT.