Cardiac computed tomography guided treatment strategy in patients with recent acute-onset chest pain

Linde, Jesper J.; Kofoed, Klaus F.; Sørgaard, Mathias; Kelbæk, Henning; Jensen, Gorm; Nielsen, Walter Bjørn; Hove, Jens D.

doi:10.1016/j.ijcard.2013.08.020

Cited by 56 publications

(37 citation statements)

References 29 publications

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“…Furthermore, the diagnostic accuracy for SPECT was in line with data from the multicenter CE-MARC study, i.e., consistent with studies using meticulous methodology, but deviant from results obtained in specialized SPECT centers without core laboratory analysis. In support of the findings from multicenter studies, the CATCH study reported a positive predictive value for CCTA to diagnose CAD of 71% vs. only 36% for standard care using stress testing [27]. In the SCOT-HEART multicenter study [28], 9,849 patients with stable chest pain were randomized to two groups, CCTA plus standard of care and standard of care alone, and were followed for a mean of 1.7 years.…”

Section: Direct Comparison Of Stress Testing To Ccta For the Diagnosimentioning

confidence: 99%

Cardiac CT vs. Stress Testing in Patients with Suspected Coronary Artery Disease: Review and Expert Recommendations

Rahsepar

Arbab‐Zadeh

2015

Curr Cardiovasc Imaging Rep

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Diagnosis and management of coronary artery disease represent a major challenge to our health care systems affecting millions of patients each year. Until recently, the diagnosis of coronary artery disease could be conclusively determined only by invasive coronary angiography. To avoid risks from cardiac catheterization, many healthcare systems relied on stress testing as gatekeeper for coronary angiography. Advancements in cardiac computed tomography angiography technology now allows to noninvasively visualize coronary artery disease, challenging the role of stress testing as the default noninvasive imaging tool for evaluating patients with chest pain. In this review, we summarize current data on the clinical utility of cardiac computed tomography and stress testing in stable patients with suspected coronary artery disease.

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Section: Direct Comparison Of Stress Testing To Ccta For the Diagnosimentioning

confidence: 99%

Cardiac CT vs. Stress Testing in Patients with Suspected Coronary Artery Disease: Review and Expert Recommendations

Rahsepar

Arbab‐Zadeh

2015

Curr Cardiovasc Imaging Rep

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“…The CATCH study recently demonstrated that a CCTA-guided strategy was associated with a higher positive predictive value for detecting CAD than conventional stress testing of patients with acute-onset chest pain, in whom acute coronary syndromes had been ruled out [5]. Furthermore, a newly published meta-analysis states that the diagnostic accuracy of CCTA is higher than exercise-ECG and SPECT [11].…”

Section: Discussionmentioning

confidence: 99%

“…Patients for this study were derived from the cohort of patients included in the CATCH (Cardiac CT in the Treatment of Acute Chest Pain) trial [5]. In the period 2010-2013, patients admitted to Hvidovre University Hospital with acute-onset chest pain and with suspicion of CAD, but with normal ECG at rest, normal biomarkers and no recurrence of chest pain during an observation period of at least 24 h, who were referred for subsequent outpatient clinical evaluation, were included.…”

Section: Methodsmentioning

confidence: 99%

“…A β-blocker (metoprolol tablet, 50-150 mg) was administered to all patients with heart rates >60 beats/min prior to scanning, unless the systolic blood pressure was <100 mm Hg or other contraindications were present [5]. The scan protocol included an initial noncontrast examination to record the coronary calcium score (CACS) and then a contrast-enhanced CCTA was performed.…”

Section: Methodsmentioning

confidence: 99%

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Diagnostic Value of the Updated Diamond and Forrester Score to Predict Coronary Artery Disease in Patients with Acute-Onset Chest Pain

et al. 2015

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Objectives: In the recently updated clinical guidelines from the European Society of Cardiology on the management of stable coronary artery disease (CAD), the updated Diamond Forrester score has been included as a pretest probability (PTP) score to select patients for further diagnostic testing. We investigated the validity of the new guidelines in a population of patients with acute-onset chest pain. Methods: We examined 527 consecutive patients with either an exercise-ECG stress test or single-photon emission computed tomography, and subsequently coronary computed tomography angiography (CCTA). We compared the diagnostic accuracy of PTP and stress testing assessed by the area under the receiver operating characteristic curve (AUC) to identify significant CAD, defined as at least 1 coronary artery branch with >70% diameter stenosis identified by CCTA. Results: The diagnostic accuracy of PTP was significantly higher than the stress test (AUC 0.80 vs. 0.69; p = 0.009), but the diagnostic accuracy of the combination of PTP and a stress test did not significantly increase when compared to PTP alone (AUC 0.86 vs. 0.80; p = 0.06). Conclusions: PTP using the updated Diamond and Forrester Score is a very useful tool in risk-stratifying patients with acute-onset chest pain at a low-to-intermediate risk of having CAD. Adding a stress test to PTP does not appear to offer significant diagnostic benefit.

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“…In this study, participants were divided into three subpopulations: low CAD prevalence (CGPS participants), i ntermedi ate CAD prevalence (CATCH participants [17]), and high CAD prevalence (VERDICT participants).…”

Section: Introductionmentioning

confidence: 99%

Reproducibility of coronary atherosclerotic plaque characteristics in populations with low, intermediate, and high prevalence of coronary artery disease by multidetector computer tomography: a guide to reliable visual coronary plaque assessments

Knegt

Linde

Fuchs

et al. 2016

Int J Cardiovasc Imaging

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To evaluate the interobserver agreement of visual coronary plaque characteristics by 320-slice multidetector computed tomography (MDCT) in three populations with low, intermediate and high CAD prevalence and to identify determinants for the reproducible assessment of these plaque characteristics. 150 patients, 50 asymptomatic subjects from the general population (low CAD prevalence), 50 symptomatic non-acute coronary syndrome (non-ACS) patients (intermediate CAD prevalence), and 50 ACS patients (high CAD prevalence), matched according to age and gender, were retrospectively enrolled. All coronary segments were evaluated for overall image quality, evaluability, presence of CAD, coronary stenosis, plaque composition, plaque focality, and spotty calcification by four readers. Interobserver agreement was assessed using Fleiss' Kappa (κ) and intra-class correlation (ICC). Widely used clinical parameters (overall scan quality, presence of CAD, and determination of coronary stenosis) showed good agreement among the four readers, (ICC = 0.66, κ = 0.73, ICC = 0.74, respectively). When accounting for heart rate, body mass index, plaque location, and coronary stenosis above/below 50 %, interobserver agreement for plaque composition, presence of CAD, and coronary stenosis improved to either good or excellent, (κ = 0.61, κ = 0.81, ICC = 0.78, respectively). Spotty calcification was the least reproducible parameter investigated (κ = 0.33). Across subpopulations, reproducibility of coronary plaque characteristics generally decreased with increasing CAD prevalence except for plaque composition, (limits of agreement: ±2.03, ±1.96, ±1.79 for low, intermediate and high CAD prevalence, respectively). 320-slice MDCT can be used to assess coronary plaque characteristics, except for spotty calcification. Reproducibility estimates are influenced by heart rate, body size, plaque location, and degree of luminal stenosis.

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Cardiac computed tomography guided treatment strategy in patients with recent acute-onset chest pain

Cited by 56 publications

References 29 publications

Cardiac CT vs. Stress Testing in Patients with Suspected Coronary Artery Disease: Review and Expert Recommendations

Cardiac CT vs. Stress Testing in Patients with Suspected Coronary Artery Disease: Review and Expert Recommendations

Diagnostic Value of the Updated Diamond and Forrester Score to Predict Coronary Artery Disease in Patients with Acute-Onset Chest Pain

Reproducibility of coronary atherosclerotic plaque characteristics in populations with low, intermediate, and high prevalence of coronary artery disease by multidetector computer tomography: a guide to reliable visual coronary plaque assessments

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