Impact of 64-slice coronary CT on the management of patients presenting with acute chest pain: results of a prospective two-centre study

Christiaens, Luc; Duchat, Florent; Boudiaf, Mourad; Tasu, J.P.; Fargeaudou, Y.; Ledref, O.; Soyer, Philippe; Sirol, Marc

doi:10.1007/s00330-011-2354-5

Cited by 8 publications

(10 citation statements)

References 36 publications

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“…Initially, 952 articles were identified for screening, 81 met criteria for full‐text review, and 33 articles were included in this meta‐analysis. Of the 33 studies, seven were randomized controlled trials, 30–36 17 were prospective cohort studies, 37–53 and the remaining nine were retrospective cohort studies 54–62 …”

Section: Resultsmentioning

confidence: 99%

“…Of the 33 studies, 30 provided age and gender estimates capable of pooling with an overall mean (±SD) age of 54 (±11) years with 47% female. Twenty‐one studies evaluated MACE events occurring at a 1‐month follow‐up endpoint 30,31,33–35,37–40,42–49,54,56–58 …”

Section: Resultsmentioning

confidence: 99%

“…Eleven studies remained between both the MPS and the cCTA having an overall event rate of 0.15% (95% CI = 0.06% to 0.41%) with no significant difference found between the two groups’ rate of MACE and both having low within‐group heterogeneity (Figure 2). 32,36,41,42,45–47,54,61–63 …”

Section: Resultsmentioning

confidence: 99%

“…A subgroup analysis within the cCTA cohort was performed to assess the effect of being classified as nonobstructive CAD (<50% stenosis) compared to no identified stenosis. There were 17 studies included for the 1‐month endpoint 30,31,33,34,37–40,42–47,54,56–58 41,43,46,47,56 .…”

Section: Resultsmentioning

confidence: 99%

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Major adverse cardiac events after emergency department evaluation of chest pain patients with advanced testing: Systematic review and meta‐analysis

Mehta

McDonald

Hirani

et al. 2021

Academic Emergency Medicine

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Objectives Our primary objective was to describe the risk of major adverse cardiac events (MACE) at 1, 6, and 12 months after a negative coronary computed tomography angiogram (cCTA), electrocardiogram (ECG) stress test, stress echocardiography, and myocardial perfusion scintigraphy (MPS) in low‐ to intermediate‐risk patients. Methods Initially, 952 articles were identified for screening, 81 met criteria for full‐text review, and once risk of bias was assessed, 33 articles were included in this meta‐analysis. We utilized a random‐effects model to assess pooled MACE event proportion for patients undergoing evaluation of acute coronary syndrome (ACS) when risk stratified to a low‐ to intermediate‐risk category after undergoing standard testing. Heterogeneity analysis was performed using Cochrane's Q‐test and I2 statistic. Results Twenty‐one studies evaluated follow‐up at 1 month with cCTA having a 0.09% (95% confidence interval [CI] = 0.03% to 0.26%) pooled MACE compared to 0.23% (95% CI = 0.01% to 5.8%) of the exercise stress testing (p = 1). MPS and cCTA had an overall event rate of 0.15% (95% CI = 0.06% to 0.41%) at 6 months (I2 = 0%). At 12 months, a subgroup analysis found a pooled cCTA MACE of 0.16% (95% CI = 0.04% to 0.65%) compared to 1.68% (95% CI = 0.01% to 2.6%) for stress echocardiography with low within‐group heterogeneity (I2 = 0%). Subgroup analysis of cCTA with no disease versus nonobstructive disease (<50% stenosis) did not find statistical difference in the MACE at both 1 month (0.17% [95% CI = 0.04% to 0.67%] vs. 0.06% [95% CI = 0.01% to 0.34%]) and 12 months (0.44% [95% CI = 0.09% to 2.2% vs. 0.54% [95% CI = 0.19% to 1.5%]). Conclusions Patients presenting with chest pain who have a coronary CTA showing < 50% stenosis, negative ECG stress test, stress echocardiography, or stress myocardial perfusion scan in the past 12 months can be discharged without any further risk stratification if their ECG and troponin are reassuring given low MACE.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Major adverse cardiac events after emergency department evaluation of chest pain patients with advanced testing: Systematic review and meta‐analysis

Mehta

McDonald

Hirani

et al. 2021

Academic Emergency Medicine

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“…However in patients who show a normal ECG and normal myocardial enzyme levels or who have uninterpretable or non-diagnostic ECG results, coronary CT angiography has been shown to be more efficient with better cost-effectiveness and safety in the planning of future treatment (18, 19, 20, 21). Patients who visit the hospital with acute chest pain who also have negative coronary CT angiography results are at very low risk for future major adverse cardiac events (MACEs) such as death by cardiovascular disease, myocardial infarction, and revascularization (22, 23, 24). Also, in patients with chest pain of unknown causes, the three most common fatal causes of chest pain (CAD, acute coronary syndrome, pulmonary thromboembolism) can be differentiated in a safe and effective manner by CT (25, 26, 27, 28, 29, 30).…”

Section: Prefacementioning

confidence: 99%

Korean Guidelines for the Appropriate Use of Cardiac CT

et al. 2015

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The development of cardiac CT has provided a non-invasive alternative to echocardiography, exercise electrocardiogram, and invasive angiography and cardiac CT continues to develop at an exponential speed even now. The appropriate use of cardiac CT may lead to improvements in the medical performances of physicians and can reduce medical costs which eventually contribute to better public health. However, until now, there has been no guideline regarding the appropriate use of cardiac CT in Korea. We intend to provide guidelines for the appropriate use of cardiac CT in heart diseases based on scientific data. The purpose of this guideline is to assist clinicians and other health professionals in the use of cardiac CT for diagnosis and treatment of heart diseases, especially in patients at high risk or suspected of heart disease.

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Low-tube-voltage selection for triple-rule-out CTA: relation to patient size

et al. 2016

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ObjectivesTo investigate the relationship between image quality and patient size at 100 kilovoltage (kV) compared to 120 kV ECG-gated Triple-Rule-Out CT angiography (TRO-CTA).MethodsWe retrospectively included 73 patients (age 64 ± 14 years) who underwent retrospective ECG-gated chest CTA. 40 patients were scanned with 100 kV while 33 patients with 120 kV. Body mass index (BMI), patients’ chest circumference (PC) and thoracic surface area (TSA) were recorded. Quantitative image quality was assessed as vascular attenuation in the ascending aorta (AA), pulmonary trunk (PA) and left coronary artery (LCA) and the signal-to-noise ratio (SNR) in the AA.ResultsThere was no significant difference in BMI (26.0 ± 4.6 vs. 28.0 ± 6.7 kg/m2), PC (103 ± 7 vs. 104 ± 10 cm2) and TSA (92 ± 15 vs. 91 ± 19 cm2) between 100 kV and 120 kV group. Mean vascular attenuation was significantly higher in the 100 kV compared to the 120 kV group (AA 438 vs. 354 HU, PA 460 vs. 349 HU, LCA 370 vs. 299 HU all p < 0.001). SNR was not significantly different, even after adjusting for patient size. Radiation dose was significantly lower in the 100 kV group (10.7 ± 4.1 vs. 20.7 ± 10.7 mSv; p < 0.001).Conclusions100 kV TRO-CTA is feasible in normal-to-overweight patients while maintaining image quality and achieving substantial dose reduction.Key Points• 100 kV protocols result in a significantly lower radiation dose. • Mean vascular attenuation is significantly higher using 100 kV. • SNR and CNR are not significantly different between 100 kV and 120 kV. • 100 kV CTA is feasible regardless of patient size while maintaining image quality.

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Impact of 64-slice coronary CT on the management of patients presenting with acute chest pain: results of a prospective two-centre study

Cited by 8 publications

References 36 publications

Major adverse cardiac events after emergency department evaluation of chest pain patients with advanced testing: Systematic review and meta‐analysis

Major adverse cardiac events after emergency department evaluation of chest pain patients with advanced testing: Systematic review and meta‐analysis

Korean Guidelines for the Appropriate Use of Cardiac CT

Low-tube-voltage selection for triple-rule-out CTA: relation to patient size

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