Multidetector computed tomography-guided treatment strategy in patients with non-ST elevation acute coronary syndromes: a pilot study

Abstract

Patients with non-ST elevation acute coronary syndrome (ACS) and evidence of myocardial ischaemia are scheduled for coronary angiography (CAG). In most patients CAG remains a single diagnostic procedure only. A prospective study was performed to evaluate whether 16-slice multidetector CT (MDCT) could predict treatment of the patients and to determine how many CAGs could have been prevented by MDCT scanning prior to CAG. Twenty-two patients with ACS were scanned prior to CAG. Based on MDCT data, a fictive treatment was proposed and compared to CAG-based treatment. Excellent accuracy was observed to detect significant stenoses using MDCT (sensitivity 94%, specificity 96%). In 45%, no PCI was performed during CAG, because of the absence of significant coronary artery disease (27%) or severe coronary artery disease, demanding CABG (18%). MDCT predicted correct treatment in 86%. By using MDCT data, 32% of the CAGs could have been prevented.

Evaluation of right ventricular function with multidetector computed tomography: comparison with magnetic resonance imaging and analysis of inter- and intraobserver variability

“…MRI, as the currently accepted reference standard for volume measurements of the cardiac chambers, is in some cases contraindicated (e.g., pacemakers) and has a long duration as well as high costs. In recent studies it became clear that MDCT has a high negative predictive value concerning the presence of significant coronary artery stenoses [3][4][5][6][7][8][9][10] and has the potential to assess right ventricular function [11]. It would be a clinical advantage if the same coronary MDCT examination could be used to noninvasively measure global right ventricular function, since the right ventricle is important in a wide range of cardiac diseases [12][13][14][15].…”

Use of multidetector computed tomography for the assessment of acute chest pain: a consensus statement of the North American Society of Cardiac Imaging and the European Society of Cardiac Radiology

“…In a pilot study of 22 patients, Dorgelo et al [45] reported on the potential use of MDCT to triage patients with ACS among conservative treatment, percutaneous intervention or bypass grafting. They followed a simplified stratification scheme, taking the number of coronary vessels into account affected by coronary artery disease with stenosis ≥50%.…”

Angiografia coronariana minimamente invasiva através de tomografia com múltiplos detectores

“…Patients with unstable angina present coronary atherosclerosis plaques that are consistently less dense than those found in patients with stable angina 17,18 . Dorgelo et al 19 , studying patients diagnosed with acute coronary syndrome, that did not present an elevated ST segment, using CTs with sixteen rows of detectors, obtained an excellent correlation in comparison to a conventional angiography (sensitivity 94%, specifi city 96%). In these cases , 45% of the patients were not submitted to a percutaneous intervention as there was no signifi cant obstruction (27%) or surgical revascularization was required (18%).…”