J Korean Med Sci.  2010 Mar;25(3):466-471. 10.3346/jkms.2010.25.3.466.

Efficacy and Safety of the Computed Tomography Coronary Angiography Based Approach for Patients with Acute Chest Pain at an Emergency Department: One Month Clinical Follow-up Study

• Kim J
• Lee H
• Song S
• Park J
• Jae H
• Lee W
• Shin S
• Jung S
• Kwak Y
• Suh G
• Park J

• KMID: 1778045
• DOI: http://doi.org/10.3346/jkms.2010.25.3.466

Abstract

To evaluate the safety and efficacy of the computed tomography coronary angiography (CTCA) for evaluation of acute chest pain in real world population, we prospectively enrolled 296 patients with acute chest pain at emergency department (ED) from November 2005 to February 2007. The patients were grouped based on the clinical information and CTCA result. The patients with a low risk profile and no significant coronary stenosis (>50%) in CTCA were discharged immediately (Group 1, n=103). On the other hand, the patients with an intermediate risk profile without significant stenosis were observed in ED for 24 hr (Group 2, n=104). The patients with significant stenosis underwent further coronary evaluation and management accordingly (Group 3, n=89). While no false negative case was found in Group 1, seven cases (6.73%) were found in Group 2, mostly during the observation period. In Group 3, there were 54 (60.67%) cases of acute coronary syndrome including 10 myocardial infarctions. The overall accuracy of CTCA for acute coronary syndrome was 88.5% (sensitivity), 85.1% (specificity), 60.7% (positive predictive value) and 96.6% (negative predictive value). In conclusion, clinical decision based on CTCA is safe and effective for low risk patients. Further validation is needed in patients with intermediate risk profile.

Keyword

Angina; Diagnosis; Imaging; Angiography; Coronary Disease; Tomography

MeSH Terms

Adult
Aged
*Chest Pain/diagnosis/etiology/radiography
Coronary Angiography/*methods
Coronary Stenosis/radiography
Decision Making
Emergency Service, Hospital
Female
Follow-Up Studies
Humans
Male
Middle Aged
Prospective Studies
Risk Factors
Sensitivity and Specificity
Tomography, X-Ray Computed/*methods

Figure

• 

  Fig. 1 Study protocol of CTCA based approach for acute chest pain patients. This flowchart shows CTCA based approach for patients with acute chest pain in our ED. Every patient without contraindication who visited our ED had CTCA and managed according to clinical risk profile and result of CTCA analysis. CTCA, computed tomography coronary angiography; ED, emergency department.

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