Multislice CT rapidly determines chest pain origin
NEW YORK (Reuters Health) - Multi-slice CT coronary angiography (MSCT) can often provide the final word on whether acute chest pain stems from coronary disease or not, new research shows. Moreover, this modality can shave hours off the time it takes to reach a diagnosis with standard methods.
However, at present, the imaging modality is limited in its ability to assess the physiologic significance of intermediate-severity coronary disease.
"The new 64-slice CT scanners give us amazing pictures of the heart," Dr. James A. Goldstein, from William Beaumont Hospital in Royal Oak, Mich., said in a statement. "With this very simple outpatient scan, you can rapidly determine whether the arteries are normal or abnormal--and if they're abnormal, whether the disease is mild, moderate, or severe."
The findings, which appear in the Journal of the American College of Cardiology (JACC) for Feb. 27, are based on a study of 197 patients who presented to the ER with acute chest pain and were randomized to be evaluated with MSCT or with a standard work-up, which included serial ECG and cardiac enzyme assessment.
Patients with minimal disease on MSCT were discharged, those with severe lesions (>70% stenosis) underwent catheterization, and those with intermediate or non-diagnostic scans were evaluated with stress testing.
MSCT-based and standard diagnostic strategies were both 100% safe, the report indicates. MSCT alone was able to accurately determine the origin of chest pain in 75% of patients -- 67 with normal coronary arteries and 8 with severe lesions. Stress testing was required in the remaining 25% of patients.
Compared with the standard approach, MSCT was associated with a drop in the diagnostic time from 15.0 to 3.4 hours and with a reduction in cost from $1,872 to $1,586. Moreover, the rate of repeat evaluations for recurrent chest pain with MSCT was 2.0% compared with 7% for the standard approach.
"These data demonstrate a potential application of CT angiography for the rapid assessment of chest pain in the ER," Dr. Anthony N. DeMaria, the journal's editor-in-chief, said in a statement. "However, it must be acknowledged that the patient population was limited, confined to low risk individuals based upon initial evaluation, and that the primary benefit was in detecting abnormalities sooner and more inexpensively, but not more accurately. The effect of the earlier diagnosis upon outcome also remains to be determined."
J Am Coll Cardiol 2007;49:863-871.