64-Slice CT coronary angiography in patients with non-ST elevation acute coronary syndrome

Abstract

64-slice CTCA has a high sensitivity to detect significant coronary stenoses, and is reliable to exclude the presence of significant coronary artery disease in patients who present with a non-ST elevation ACS.

Transitioning from 16-slice to 64-slice multidetector computed tomography for the assessment of coronary artery disease: Are we really making progress?

“…Sensitivity for significant stenosis in severely calcified coronary segments remained high (93% to 100%) for 64-slice MDCT (8,12,17). Unfortunately, specificity for significant stenosis was variable (67% to 92%) in the setting of severe calcification, suggesting that calcification-associated artefact with 64-slice MDCT leads predominantly to overestimation of lesion obstruction (8,12,17).…”

“…Currently, 15 studies have examined 64-slice technology for the evaluation of suspected CAD (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) (Figure 2). In these studies, 64-slice MDCT was able to assess 97% of all coronary artery segments visualized by both CCA and MDCT (Table 1), which is approximately 5% more than previous 16-slice technology.…”

“…Furthermore, when using patient-based analysis, defined as the presence of one or more significant coronary artery lesions in a study subject, sensitivity for 64-slice MDCT ranged between 88% to 100% in the 15 studies reviewed (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). Additionally, in study populations with a low prevalence of CAD (32%), per-patient sensitivity remained very high (96%) (9).…”

One‐year Outcomes Following Coronary Computerized Tomographic Angiography for Evaluation of Emergency Department Patients with Potential Acute Coronary Syndrome

“…[2][3][4][5][6][7][8][9][10][11][12][13] Although clinical algorithms can successfully risk stratify patients, they have not typically been considered useful in identifying a group of patients with a 30-day 1% risk for an adverse event who can safely be discharged from the ED. [2][3][4][5][6][7][8][9][10][11][12][13][14] Coronary computerized tomographic angiography (CTA) has been shown to have excellent diagnostic accuracy when compared to cardiac catheterization [15][16][17][18][19][20][21] and appears to perform as well as myocardial perfusion imaging in identifying patients at low risk for cardiovascular events. [22][23][24][25][26] Observational studies of coronary CTA have found that patients with normal coronary CTA results are at low risk for adverse events over 1-2 years; however, these studies either were small or involved patients who had other standard assessments to aid in clinical management.…”

Comparison of Diagnostic Accuracy of 64-Slice Computed Tomography Coronary Angiography in Patients with Low, Intermediate, and High Cardiovascular Risk

“…Sixty-four-slice computed tomography (CT) has been shown to be a reliable noninvasive tool to document or rule out significant coronary artery lesions (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). In particular, the high negative predictive value (NPV) of CT coronary angiography (CTCA), demonstrated in all studies (1-10), has been suggested to obviate the need for invasive coronary angiography (ICA) in patients whose symptoms or abnormal stress test results require ruling out the presence of coronary artery disease (CAD) (11).…”