Background: Previous studies have shown the safety of 64 slice coronary CT angiography (CCTA) for triage of emergency department (ED) pts with chest pain. We evaluated the safety and longer term prognostic value of 256 slice CCTA in ED pts with acute chest pain.
Methods: 256-slice CCTA was performed in 384 ED pts (55±12 yrs, 42% female) with acute chest pain. All had no known CAD, negative troponin and no ischemic ECG changes. MACE (CV death, non fatal MI or revascularization) were recorded over 34±11 (range 18-53) months.
Results: Normal coronary arteries were detected in 158 pts, non obstructive atheroma (<50% stenosis) in 150 and obstructive (>50% stenosis) CAD in 76. There were no early (up to 3 months) CV events in pts with normal CCTA. MACE (early and late) was related to CCTA disease severity (Table). There was 1 minor late MI at 7 months in an 87 y/o with normal ED CCTA. Univariate predictors of MACE were: obstructive CAD, coronary calcium score, age, diabetes mellitus, hypertension and male sex. In a multivariable model however, only the presence of obstructive CAD by CCTA and calcium score remained significant independent correlates of MACE.
Conclusions: In symptomatic ED pts undergoing 256-slice CCTA: 1. Pts with normal CCTA had no short term (3 month) MACE. 2. Normal CCTA conferred excellent long term outcome up to 4 years. 3. Early and late MACE increased with severity of obstruction and overall extent of calcified plaque.
Table: MACE events in relation to ED 256-slice CCTA findings (N=384)
| CCTA CAD severity |
CV death |
Non fatal MI |
Coronary revascularization |
| |
|
Early (3 months) |
Late |
Early (3 months) |
Late |
| Normal coronary arteries (N=158) |
0 |
0 |
1 (0.6%) |
0 |
0 |
| Non- obstructive atheroma (N=150) |
0 |
1 (0.6%) |
3 (2%) |
4 (2.6%) |
6 (4%) |
| Obstructive CAD (N=76) |
0 |
4 (5.2%) |
0 |
46 (60.5%) |
5 (6.5%) |
