Abstract 04: Diagnostic Accuracy of Coronary CT in Survivors of Out-Of-Hospital Circulatory Arrest: Can CT Serve as a Gatekeeper for Invasive Coronary Angiography?

Abstract

Introduction: Out-of-hospital circulatory arrest (OHCA) is commonly assumed to be from a cardiac cause although routine early invasive coronary angiography (ICA) remains controversial and has a relatively high proportion of studies without obstructive coronary artery disease (CAD). The ability of coronary CT angiography (CCTA) to detect significant CAD in OHCA survivors has not been evaluated. Methods: The prospective CT-FIRST trial enrolled 104 OHCA survivors who had an early (<6 hours from hospital arrival) head-to-pelvis CT scan that included an ECG-gated CCTA (FORCE CT, Siemens). The CCTA scanned 0-90% of the cardiac cycle without routine use of beta blockers or nitroglycerin. Treating physicians were blinded to the CCTA analysis. ICA was ordered at the discretion of treating physicians. Readers blinded to corresponding studies analyzed CCTA and ICA for coronary stenoses using a 20 segment coronary model. Obstructive CAD was assumed for >50% stenosis. Patient-level diagnostic accuracy calculations for CCTA to identify obstructive CAD used ICA as the standard. Results: Of the 104 enrolled patients, 28 (27%) had both CT and ICA. All CCTA studies were evaluable. Diagnostic accuracy data are shown in the Table. Overall, diagnostic accuracy measures were excellent between CCTA and ICA at the patient level. Conclusions: Early CCTA in OHCA survivors has high diagnostic accuracy for obstructive coronary artery disease and could be used as a gatekeeper to ICA.