Journal of Cardiovascular Computed Tomography
Volume 3, Issue 1, Supplement , Pages S13-S22 , January 2009

Role of computed tomography in the evaluation of acute chest pain

Received 24 June 2008 ,Accepted 25 November 2008.

References 

  1. Nawar EW, Niska RW, Xu J. National Hospital Ambulatory Medical Care Survey: 2005 emergency department summary. Adv Data. 2007;389:1–32
  2. Jagminas L, Partridge R. A comparison of emergency department versus in hospital chest pain observation units. Am J Emerg Med. 2005;23:111–113
  3. Gibler WB, Lewis LM, Erb RE, Makens PK, Kaplan BC, Vaughn RH, et al. Early detection of acute myocardial infarction in patients presenting with chest pain and nondiagnostic ECGs: serial CK-MB sampling in the emergency department. Ann Emerg Med. 1990;19:1359–1366
  4. Pope JH, Aufderheide TP, Ruthazer R, Woolard RH, Feldman JA, Beshansky JR, et al. Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med. 2000;342:1163–1170
  5. Broder J, Warshauer DM. Increasing utilization of computed tomography in the adult emergency department, 2000–2005. Emerg Radiol. 2006;13:25–30
  6. von Kodolitsch Y, Schwartz AG, Nienaber CA. Clinical prediction of acute aortic dissection. Arch Intern Med. 2000;160:2977–2982
  7. Klompas M. Does this patient have an acute thoracic aortic dissection?. JAMA. 2002;287:2262–2272
  8. Nienaber C, Fattori R. Aortic diseases-do we need MR techniques?. Herz. 2000;4:331–341
  9. Weber T. D-dimer in acute aortic dissection. Chest. 2003;123:1375–1378
  10. Ohlmann P, Faure A, Morel O, Petit H, Kabbaj H, Meyer N, et al. Diagnostic and prognostic value of circulating D-Dimers in patients with acute aortic dissection. Crit Care Med. 2006;34:1358–1364
  11. Shiga T, Wajima Z, Apfel CC, Inoue T, Ohe Y. Diagnostic accuracy of transesophageal echocardiography, helical computed tomography, and magnetic resonance imaging for suspected thoracic aortic dissection: systematic review and meta-analysis. Arch Intern Med. 2006;166:1350–1356
  12. Yoshida S, Akiba H, Tamakawa M, Yama N, Hareyama M, Morishita K, et al. Thoracic involvement of type A aortic dissection and intramural hematoma: diagnostic accuracy–comparison of emergency helical CT and surgical findings. Radiology. 2003;228:430–435
  13. Hayter RG, Rhea JT, Small A, Tafazoli FS, Novelline RA. Suspected aortic dissection and other aortic disorders: multi-detector row CT in 373 cases in the emergency setting. Radiology. 2006;238:841–852
  14. Lee DY, Williams DM, Abrams GD. The dissected aorta: part II. Differentiation of the true from the false lumen with intravascular US. Radiology. 1997;203:32–36
  15. Takahashi K, Stanford W. Multidetector CT of the thoracic aorta. Int J Cardiovasc Imaging. 2005;21:141–153
  16. Salvolini L, Renda P, Fiore D, Scaglione M, Piccoli G, Giovagnoni A. Acute aortic syndromes: role of multi-detector row CT. Eur J Radiol. 2008;65:350–358
  17. Castañer E, Andreu M, Gallardo X, Mata JM, Cabezuelo MA, Pallardó Y. CT in nontraumatic acute thoracic aortic disease: typical and atypical features and complications. Radiographics. 2003;23(Spec No):S93–S110
  18. The PIOPED Investigators. Ventilation/perfusion scan in acute pulmonary embolism: results of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED). JAMA. 1990;23:2753–2759
  19. Wells PS, Ginsberg JS, Anderson DR, Kearon C, Gent M, Turpie AG, et al. Use of a clinical model for safe management of patients with suspected pulmonary embolism. Ann Intern Med. 1998;129:997–1005
  20. Wicki J, Perneger TV, Junod AF, Bounameaux H, Perrier A. Assessing clinical probability of pulmonary embolism in the emergency ward: a simple score. Arch Intern Med. 2001;161:92–97
  21. Heit JA, Minor TA, Andrews JC, Larson DR, Li H, Nichols WL. Determinants of plasma fibrin D-dimer sensitivity for acute pulmonary embolism as defined by pulmonary angiography. Arch Pathol Lab Med. 1999;123:235–240
  22. Fedullo PF, Tapson VF. Clinical practice. The evaluation of suspected pulmonary embolism. N Engl J Med. 2003;349:1247–1256
  23. Stein PD, Hull RD, Patel KC, Olson RE, Ghali WA, Brant R, et al. D-dimer for the exclusion of acute venous thrombosis and pulmonary embolism: a systematic review. Ann Intern Med. 2004;140:589–602
  24. Eng J, Krishnan JA, Segal JB, Bolger DT, Tamariz LJ, Streiff MB, et al. Accuracy of CT in the diagnosis of pulmonary embolism: a systematic literature review. Am J Roentgenol. 2004;183:1819–1827
  25. Qanadli SD, Hajjam ME, Mesurolle B, Barré O, Bruckert F, Joseph T, et al. Pulmonary embolism detection: prospective evaluation of dual-section helical CT versus selective pulmonary arteriography in 157 patients. Radiology. 2000;217:447–455
  26. Winer-Muram HT, Rydberg J, Johnson MS, Tarver RD, Williams MD, Shah H, et al. Suspected acute pulmonary embolism: evaluation with multi-detector row CT versus digital subtraction pulmonary arteriography. Radiology. 2004;233:806–815
  27. Stein PD, Fowler SE, Goodman LR, Gottschalk A, Hales CA, Hull RD, et al. Investigators PIOPED II: Multidetector computed tomography for acute pulmonary embolism. N Engl J Med. 2006;354:2317–2327
  28. van Belle A, Büller HR, Huisman MV, Huisman PM, Kaasjager K, Kamphuisen PW, et al. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA. 2006;295:172–179
  29. van Beek EJ, Brouwerst EM, Song B, Stein PD, Oudkerk M. Clinical validity of a normal pulmonary angiogram in patients with suspected pulmonary embolism–a critical review. Clin Radiol. 2001;56:838–842
  30. Righini M, Legal G, Aujesky D, Roy P, Sanchez O, Verschuren F, et al. Diagnosis of pulmonary embolism by multidetector CT alone or combined with venous ultrasonography of the leg: a randomised non-inferiority trial. Lancet. 2008;371:1343–1352
  31. Thom T. Heart disease and stroke statistics–2006 Update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circ J. 2006;113:e85–e151
  32. Gersh BJ, Stone GW, White HD, Holmes DR. Pharmacological facilitation of primary percutaneous coronary intervention for acute myocardial infarction: is the slope of the curve the shape of the future?. JAMA. 2005;293:979–986
  33. Panju AA, Hemmelgarn BR, Guyatt GH, Simel DL. The rational clinical examination. Is this patient having a myocardial infarction?. JAMA. 1998;280:1256–1263
  34. Saenger A, Jaffe A. The use of biomarkers for the evaluation and treatment of patients with acute coronary syndromes. Med Clin North Am. 2007;91:657–681
  35. Rouan GW, Lee TH, Cook EF, Brand DA, Weisberg MC, Goldman L. Clinical characteristics and outcome of acute myocardial infarction in patients with initially normal or nonspecific electrocardiograms (a report from the Multicenter Chest Pain Study). Am J Cardiol. 1989;64:1087–1092
  36. Pollack CV. Application of the TIMI risk score for unstable angina and non-ST elevation acute coronary syndrome to an unselected emergency department chest pain population. Acad Emerg Med. 2005;13:13–18
  37. Hayashida K. Serum soluble lectin-like oxidized low-density lipoprotein receptor-1 levels are elevated in acute coronary syndrome: a novel marker for early diagnosis. Circ J. 2005;112:812–818
  38. Ng SM, Krishnaswamy P, Morissey R, Clopton P, Fitzgerald R, Maisel AS. Ninety-minute accelerated critical pathway for chest pain evaluation. Am J Cardiol. 2001;88:611–617
  39. Mccord J, Nowak RM, Mccullough PA, Foreback C, Borzak S, Tokarski G, et al. Ninety-minute exclusion of acute myocardial infarction by use of quantitative point-of-care testing of myoglobin and troponin I. Circ J. 2001;104:1483–1488
  40. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15:827–832
  41. Budoff MJ, Georgiou D, Brody A, Agatston AS, Kennedy J, Wolfkiel C, et al. Ultrafast computed tomography as a diagnostic modality in the detection of coronary artery disease: a multicenter study. Circ J. 1996;93:898–904
  42. Simons DB, Schwartz RS, Edwards WD, Sheedy PF, Breen JF, Rumberger JA. Noninvasive definition of anatomic coronary artery disease by ultrafast computed tomographic scanning: a quantitative pathologic comparison study. J Am Coll Cardiol. 1992;20:1118–1126
  43. Laudon DA, Vukov LF, Breen JF, Rumberger JA, Wollan PC, Sheedy PF. Use of electron-beam computed tomography in the evaluation of chest pain patients in the emergency department. Ann Emerg Med. 1999;33:15–21
  44. McLaughlin VV, Balogh T, Rich S. Utility of electron beam computed tomography to stratify patients presenting to the emergency room with chest pain. Am J Cardiol. 1999;84:327–328A8
  45. Georgiou D, Budoff MJ, Kaufer E, Kennedy JM, Lu B, Brundage BH. Screening patients with chest pain in the emergency department using electron beam tomography: a follow-up study. J Am Coll Cardiol. 2001;38:105–110
  46. Raff GL, Gallagher MJ, Oneill W, Goldstein JA. Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J Am Coll Cardiol. 2005;46:552–557
  47. Leschka S, Alkadhi H, Plass A, Desbiolles L. Accuracy of MSCT coronary angiography with 64-slice technology: first experience. Eur Heart J. 2005;26:1482–1487
  48. Hoffmann MHK, Shi H, Schmitz BL, Schmid FT, Lieberknecht M, Schulze R, et al. Noninvasive coronary angiography with multislice computed tomography. JAMA. 2005;293:2471–2478
  49. Scheffel H, Alkadhi H, Plass A, Vachenauer R, Desbiolles L, Gaemperli O, et al. Accuracy of dual-source CT coronary angiography: first experience in a high pre-test probability population without heart rate control. Eur Radiol. 2006;16:2739–2747
  50. Vanhoenacker PK, Heijenbrok-Kal MH, Heste RV, Decramer I, Hoe LRV, Wijns W, et al. Diagnostic performance of multidetector CT angiography for assessment of coronary artery disease: meta-analysis. Radiology. 2007;244:419–428
  51. Vanhoenacker PK, Decramer I, Bladt O, Sarno G, Bevernage C, Wijns W. Detection of non-ST-elevation myocardial infarction and unstable angina in the acute setting: meta-analysis of diagnostic performance of multi-detector computed tomographic angiography. BMC Cardiovasc Disord. 2007;7:39
  52. Hacker M, Jakobs T, Hack N, Nikolaou K, Becker C, Ziegler FV, et al. Sixty-four slice spiral CT angiography does not predict the functional relevance of coronary artery stenoses in patients with stable angina. Eur J Nucl Med Mol Imaging. 2007;34:4–10
  53. Sato A, Hiroe M, Tamura M, Ohigashi H, Nozato T. Quantitative measures of coronary stenosis severity by 64-slice CT angiography and relation to physiologic significance of perfusion in nonobsese patients: Comparison with stress myocardial perfusion imaging. J Nucl Med. 2008;49:564–572
  54. Schuijf J, Wijns W, Jukema J, Atsma D, Deroos A, Lamb H, et al. Relationship between noninvasive coronary angiography with multi-slice computed tomography and myocardial perfusion imaging. J Am Coll Cardiol. 2006;48:2508–2514
  55. Gaemperli O, Schepis T, Koepfli P, Valenta I, Soyka J, Leschka S, et al. Accuracy of 64-slice CT angiography for the detection of functionally relevant coronary stenoses as assessed with myocardial perfusion SPECT. Eur J Nucl Med Mol Imaging. 2007;34:1162–1171
  56. Schuijf JD, Bax JJ. CT angiography: an alternative to nuclear perfusion imaging?. Heart. 2008;94:255–257
  57. Heller LI, Cates C, Popma J, Deckelbaum LI, Joye JD, Dahlberg ST, et al. Intracoronary Doppler assessment of moderate coronary artery disease: comparison with 201Tl imaging and coronary angiography. FACTS Study Group. Circ J. 1997;96:484–490
  58. Schroeder S, Kopp AF, Baumbach A, Meisner C, Kuettner A, Georg C, et al. Noninvasive detection and evaluation of atherosclerotic coronary plaques with multislice computed tomography. J Am Coll Cardiol. 2001;37:1430–1435
  59. Leber AW, Knez A, Ziegler FV, Becker A, Nikolaou K, Paul S, et al. Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography: a comparative study with quantitative coronary angiography and intravascular ultrasound. J Am Coll Cardiol. 2005;46:147–154
  60. Achenbach S, Ropers D, Hoffman U, MacNeill B, Baum U, Pohle K, et al. Assessment of coronary remodeling in stenotic and nonstenotic coronary atherosclerotic lesions by multidetector spiral computed tomography. J Am Coll Cardiol. 2004;43:842–847
  61. Nissen SE. Application of intravascular ultrasound to characterize coronary artery disease and assess the progression or regression of atherosclerosis. Am J Cardiol. 2002;89:24B–31B
  62. Gallagher MJ, Ross MA, Raff GL, Goldstein JA, O'Neill WW, O'Neil B. The diagnostic accuracy of 64-slice computed tomography coronary angiography compared with stress nuclear imaging in emergency department low-risk chest pain patients. Ann Emerg Med. 2007;49:125–136
  63. Hoffman U, Nagurney JT, Moselewski F, Pena A, Ferencik M, Chae CU, et al. Coronary multidetector computed tomography in the assessment of patients with acute chest pain. Circ J. 2006;114:2251–2260
  64. Rubinshtein R, Halon DA, Gaspar T, Jaffe R, Karkabi B, Flugelman MY, et al. Usefulness of 64-slice cardiac computed tomographic angiography for diagnosing acute coronary syndromes and predicting clinical outcome in emergency department patients with chest pain of uncertain origin. Circ J. 2007;115:1762–1768
  65. Goldstein JA, Gallagher MJ, O'Neill WW, Ross M, Oneil B, Raff GL. A randomized controlled trial of multi-slice coronary computed tomography for evaluation of acute chest pain. J Am Coll Cardiol. 2007;49:863–871
  66. Alfonso F. Immediate coronary imaging for acute chest pain: are we there yet? (letter). J Am Coll Cardiol. 2007;50:650–651
  67. Goldstein JA, Raff GL. Reply (letter). J Am Coll Cardiol. 2007;50:651
  68. Johnson TRC, Nikolau K, Wintersperger BJ, Knez A, Boekstegers P, Reiser MF, et al. ECG-gated 64-MDCT angiography in the differential diagnosis of acute chest pain. AJR Am J Roentgenol. 2007;188:76–82
  69. White CS, Kuo D, Kelemen M, Jain V, Musk A, Zaidi E, et al. Chest pain evaluation in the emergency department: can MDCT provide a comprehensive evaluation?. AJR Am J Roentgenol. 2005;185:533–540
  70. Raptopoulos VD. MDCT angiography of acute chest pain: evaluation of ECG-gated and nongated techniques. Am J Roentgenol. 2006;186:S346–S356
  71. Johnson TRC, Nikolaou K, Wintersperger BJ, Knez A, Boekstegers P, Reiser MF, et al. ECG-gated 64-MDCT angiography in the differential diagnosis of acute chest pain. AJR Am J Roentgenol. 2007;188:76–82
  72. Gallagher MJ, Raff GL. Use of multislice CT for the evaluation of emergency room patients with chest pain: the so-called “Triple rule-out. Catheter Cardiovasc Interv. 2007;71:92–99
  73. Hendel RC, Patel MR, Kramer CM, Poon M, Hendel RC, Carr JC, et al. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology. J Am Coll Cardiol. 2006;48:1475–1497
  74. Poon M, Rubin GD, Achenbach S, Attebery TW, Berman DS, Brady TJ, et al. Consensus update on the appropriate usage of cardiac computed tomographic angiography. J Invasive Cardiol. 2007;19:484–490

 Conflict of interest: The authors report no conflicts of interest.

PII: S1934-5925(08)00709-0

doi: 10.1016/j.jcct.2008.11.004

Journal of Cardiovascular Computed Tomography
Volume 3, Issue 1, Supplement , Pages S13-S22 , January 2009