Is Computed Tomography Coronary Angiography the Most Accurate and Effective Noninvasive Imaging Tool to Evaluate Patients With Acute Chest Pain in the Emergency Department?

Hendel, Robert C.

doi:10.1161/circimaging.109.858167

Cited by 11 publications

(1 citation statement)

References 89 publications

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“…Nevertheless, the use of CTA in this setting is limited as it exposes patients to radiation, requires iodinated contrast, and cannot provide information on functional capacity. 11 Although both CTA and ETT can be used to evaluate lowto intermediate-risk patients presenting to the emergency department, there is a paucity of studies that directly compare these tests in patients with acute chest pain. Therefore, we sought to (1) examine how data from ETT can identify patients who have coronary plaque or stenosis, using CTA as the reference standard, and (2) identify patient characteristics which could be used in selecting between ETT and CTA.…”

Section: Clinical Perspective On P 242mentioning

confidence: 99%

Comparison of Exercise Treadmill Testing With Cardiac Computed Tomography Angiography Among Patients Presenting to the Emergency Room With Chest Pain

Blankstein

Ahmed

Bamberg

et al. 2012

Circ: Cardiovascular Imaging

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Background-The aims of our study were to (1) examine how data from exercise treadmill testing (ETT) can identify patients who have coronary plaque or stenosis, using CT angiography (CTA) as the reference standard, and (2) identify patient characteristics that may be used in selecting ETT versus CTA. Methods and Results-The Rule Out Myocardial Infarction Using Computer-Assisted Tomography (ROMICAT) trial was an observational cohort study of acute chest pain patients presenting to the emergency department with normal initial troponin and a nonischemic ECG. Univariate and multivariable analyses were performed to assess the relationship of baseline clinical data and ETT parameters with coronary plaque and stenosis on CTA. Of the 220 patients who had ETT (mean age, 51 years; 63% men), 21 (10%) had positive results. A positive ETT had a sensitivity of 30% and specificity of 93% to detect Ͼ50% stenosis. The sensitivity increased to 83% after excluding uninterpretable segments and evaluating the ability to detect a Ͼ70% stenosis. Predictors of plaque included older age, male sex, diabetes, hypertension, hyperlipidemia, lower functional capacity, and a lower Duke Treadmill Score. Both a positive ETT and a low Duke Treadmill Score were significant univariate and multivariable predictors of stenosis Ͼ50% on CTA Whereas the prevalence of stenosis by CTA was greater among patients with more risk factors, coronary stenosis was not present among men Ͻ40 years old or women Ͻ50 years old or individuals who achieved at least 13 metabolic equivalents on ETT. Conclusions-Among

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Section: Clinical Perspective On P 242mentioning

confidence: 99%