131 Tomography angiography in acute coronary syndrom: The TIACS study

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• 作者：Sé ; bastien Hascoë ; t¹ ; Didier Carrié ; ¹ ; Michel Galinier¹ ; Jé ; rô ; me Roncalli¹ ; Vanina Bongard² ; Marchal Pauline¹ ; Marie-Agnes Marachet³ ; Chabbert Valerie³ ; Rousseau Herve³ ; Charpentier Sandrine⁴ ; Olivier Lairez¹ ; Meyer Elbaz¹
• 刊名：Archives of Cardiovascular Diseases Supplements
• 出版年：2011
• 出版时间：January 2011
• 年：2011
• 卷：3
• 期：1
• 页码：42
• 全文大小：65 K

文摘

Background

Triage of chest pain patients in the emergency department remains challenging. Multi-slice computed tomography angiography (CTA) has a high negative predictive value for exclusion of coronary artery stenosis.

Objectives

to assess mid-term outcomes in patients with low to intermediate likelihood of acute coronary syndrome (ACS) who underwent Multi-slice CTA.

Methods

prospective observational single-center cohort study in chest pain patients with normal troponin and non ischemic electrocardiogram. Patients with normal coronary 64-slice CTA or with stenosis less than 50 % luminal narrowing were discharged from the emergency unit. End points were coronary artery revascularizations during index hospitalization and major adverse cardiac events (MACE) during follow-up.

Results

Among 123 patients (mean age 51 +/?13 years, 70 % men), 60 were free of coronary artery disease (CAD) according to CTA (49 % ). Twentysix (21 % ) had non obstructive disease and 29 (24 % ) had inconclusive or positive computed tomography for significant stenosis. Mean radiation exposure was 21 +/?1 mSv. Twenty-seven patients had invasive coronary angiography. Ten patients (8 % ) needed coronary artery revascularizations during index hospitalization. Nine had coronary angioplasty and one patient had bypass surgery with four grafts.

During the mean follow-up of 14+/-4 months, no patient suffered from MACE including patients who had coronary artery revascularizations during index hospitalization. Negative predictive value for MACE was 100 % (95 % confident interval 98?00 % ).

Conclusions

Seventy-three percent of patients with acute chest pain and low to intermediate likelihood of ACS were free or had non-significant CAD according to CTA and no MACE during a 14 month follow-up period. Given the large number of such patients, early coronary CTA may significantly improve patients?management in the emergency department. Reduction of radiation exposure will facilitate acceptance in clinical practice.