Usefulness of multislice spiral computed tomography coronary angiography in patients with acute chest pain in the emergency department

Abstract 

Background

Despite reports that multislice spiral computed tomography (MSCT) has high sensitivity and specificity in preselected patient populations, the routine clinical feasibility and utility of MSCT coronary angiography in patients with acute chest pain in the emergency department remains uncertain.

Objectives

We sought to determine whether 16-slice MSCT coronary angiography can provide diagnostically useful images in patients with acute chest pain in the emergency department.

Methods

Ninety-eight patients in the emergency department (41 men, 57 women; mean age ± SD, 48.1 ± 11.9 y) with acute chest pain underwent MSCT coronary angiography. Coronary calcium (Agatston) scoring was performed, followed by contrast-enhanced MSCT. Images were evaluated for mean image quality (MIQ) and for degree of stenosis. These data were correlated with body mass index (BMI; in kg/m²), heart rate, beat-to-beat variation, and calcium score to assess their influence on image quality.

Results

The 28 patients (29%) with nondiagnostic MIQs had significantly higher BMIs (mean ± SD, 32.9 ± 9.1 vs 28.9 ± 6.7; P < 0.05) and heart rates (mean ± SD, 71.0 ± 11.9 beats/min vs 65.6 ± 9.9 beats/min; P < 0.05) than patients with diagnostic MIQs. Forty-five patients (46%) had at least 1 nondiagnostic coronary segment. These patients had significantly higher heart rates (mean ± SD, 70.5 ± 10.3 vs 64.1 ± 13.7; P < 0.05) than patients with only diagnostic-quality scans. Image quality correlated inversely and strongly with BMI and heart rate.

Conclusions

Sixteen-slice MSCT coronary angiography cannot routinely provide diagnostically useful images in patients with acute chest pain in the emergency department.

Keywords: Acute chest pain, Coronary calcium scoring, Emergency department, Image quality, Multislice computed tomography, X-ray computed tomography