Contrast enhanced multi‐detector computed tomography coronary angiography versus conventional invasive quantitative coronary angiography in acute coronary syndrome patients–correlation and bias

Reliability of coronary computed tomography angiography in acute coronary syndrome in an emergency setting

Background

Cardiovascular computed tomography (cardiovascular CT) is currently used as a fast non-invasive method for the visualization of coronary plaques and walls and the assessment of lumen stenosis severity. Previous studies demonstrated the high negative predictive value of CT for the exclusion of coronary lumen stenoses. In this study we hypothesize that coronary CT angiography (CTA) represents a reliable method as diagnostic procedure in acute coronary syndrome (ACS) even in emergency settings.

Methods

36 patients (51 lesions) with ACS who underwent cardiovascular CT, intravascular ultrasound (IVUS) and invasive coronary angiography (ICA) within 48 h were included. The percentage of coronary stenoses were measured and compared by three methods. Influence of available predictors that can potentially affect the measurement results was assessed.

Results

Cardiac CTA provided comparable results to IVUS (mean difference -0.45%, PPV: 98%, NPV: 75%). ICA tends to estimate lower stenoses degrees than cardiac CTA and IVUS (mean difference 13.19% and 13.64%, respectively). The final diagnosis and positive remodeling did not lead to any significant influence on measurements.

Conclusions

The cardiovascular CT results show that even in emergency settings it is possible to identify morphological changes as sequels of coronary artery sclerosis with comparable results to the reference method IVUS. Deviations of IVUS and cardiovascular CT from ICA are comparable and can to a large extent be explained by differences in the measurement technique.

New advances in cardiac computed tomography

PURPOSE OF REVIEW

Multidetector computed tomography has been growing in every way possible. The test is becoming more common in clinical practice. It has breached the public consciousness and is being asked for by name. Research in the field is accelerating. The technology is improving, as is our skill at interpretation. There have been hundreds of publications on the subject over the past year. We will address three of the most important recent areas of focus.

RECENT FINDINGS

Multidetector computed tomography has been touted as a possible 'triple rule-out' for myocardial infarction, pulmonary embolus, and aortic dissection, with an eye to improving emergency department efficiency and efficacy. A recent study has shown that, at least in low-risk patients, the triple rule-out is as safe as standard of care diagnosis, and saves considerable time and expense. Calcium scoring, hotly debated for years, has received approval from both the American Heart Association and American College of Cardiology as a screening test under certain circumstances. The 64-detector scanner has shown improvement over the 16-detector scanner.

SUMMARY

These developments indicate that multidetector computed tomography has more uses than previously realized. They also indicate that we have much more work to do before we can claim to have fully utilized this technology.