Escore de cálcio para avaliar dor torácica na sala de emergência

Abstract

Some authors have suggested that a zero calcium score (CAC) can be used to rule out the diagnosis of acute coronary syndrome.Objective this study is to evaluate the diagnostic accuracy of a zero CAC when compared to the coronary computed tomography angiography (CCTA) at the emergency department.135 symptomatic patients with no previous coronary heart disease (CHD) who presented to the emergency department were submitted to CAC and CCTA to rule out CHD. All patients had normal electrocardiogram and cardiac biomarkers and were TIMI risk score 0 to 2. The CCTA was considered positive if any obstructive lesion (> 50%) was identified.The mean age was 51.7 ± 13.6 years with 50.6% of men. Seventy-three (54.1%) patients had a calcium score of zero. Of them, 3 (4.1%) had an obstruction > 50 % and underwent invasive coronary angiography. Calcium score showed a sensitivity of 92.9%, specificity of 75.3%, positive and negative predictive values of, respectively, 62.9% and 95.9%. Positive and negative likelihood ratios were respectively of 3.7 and 0.09 to detect lesions greater than 50% in the CCTA.A negative likelihood ratio of 0.09 is very good to rule out most cases of significant coronary obstruction in epidemiologic studies. However, it is important to understand that in a clinical scenario, all evidence including history, clinical examination, data from eletrocardiogram and myocardial biomarkers have to be interpreted together. In our study, three cases with a zero CAC score had coronary obstruction higher than 50% at the CCTA.

Acute chest pain intensity in a cardiopulmonary emergency unit

“…For being unspecific, acute chest pain may be related or not to coronary disease and VAS is used to measure pain intensity and to tailor analgesic therapy; however, there are limitations with regard to the involvement of different affective and cultural variables and to multiple dimensions involved with pain, which makes the search for biochemical pain markers a relevant option 17 . A study has evaluated coronary calcium score to rule out the possibility of acute coronary syndrome and has shown that this is a good alternative to rule out most cases of coronary disease; however, it is mandatory tha such information are compared to others, such as clinical evaluation and patient's history 18 . Another study suggests acute chest pain evaluation with more objective methods, such as coronary angiotomography, for example.…”

Relationship between Calcium Score and Myocardial Scintigraphy in the Diagnosis of Coronary Disease

“…57 In such cases, CS does not add diagnostic and prognostic information, and has lower event prediction power than scintigraphy. 58-60 …”