Practicality, safety and accuracy of computed tomography coronary angiography in the evaluation of low TIMI-risk score chest pain patients: A pilot study

Kean H. Soon, Anne Maree Kelly, Nicholas Cox, Lachlan MacGregor, Ivan Chaitowitz, Kevin Bell, Yean Lim

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objectives: The present pilot study aimed to assess the practicality, safety and accuracy of performing CT coronary angiography (CT-CA) in the evaluation of acute chest pain of patients with low thrombolysis in myocardial infarction (TIMI) risk scores. Methods: The present prospective observational study was undertaken in a university teaching hospital between November 2004 and December 2005. Participants were a convenience sample of patients admitted to hospital for investigation of chest pain with TIMI risk scores <3. Consenting patients underwent CT-CA within 48 h of presentation. Outcomes of interest were practicality (proportion of diagnostic quality scans obtained and preparation time for CT-CA), rate of serious adverse events, and accuracy at the patient level using selective coronary angiography as the reference standard. Results: Thirty-four patients were recruited. Diagnostic quality scans were obtained in 26/34 or 76% of patients (four failed CT-CA and four non-diagnostic scans). The median CT preparation time was 1.9 h (range 0.17-4.0). No serious adverse events were found. Fourteen of those 26 patients with diagnostic CT-CA subsequently had selective coronary angiography, of which nine were positive. The sensitivity and specificity of CT-CA in identifying patients with significant coronary artery disease were 9/9 (100%; 95% confidence interval 72-100%) and 4/5 (80%; 95% confidence interval 28-100%), respectively. Conclusions: The majority of acute chest pain patients with low TIMI risk scores were successfully scanned with a 16-slice CT to produce CT-CA studies with good diagnostic quality and accuracy. No major adverse events were found. The place of CT-CA in diagnostic workup for chest pain remains to be defined.

Original languageEnglish (US)
Pages (from-to)129-135
Number of pages7
JournalEMA - Emergency Medicine Australasia
Volume19
Issue number2
DOIs
StatePublished - Apr 2007
Externally publishedYes

Fingerprint

Coronary Angiography
Chest Pain
Myocardial Infarction
Safety
Acute Pain
Computed Tomography Angiography
Confidence Intervals
Teaching Hospitals
Observational Studies
Coronary Artery Disease
Prospective Studies
Sensitivity and Specificity

Keywords

  • Chest pain
  • Computed tomography
  • Coronary angiography
  • Coronary artery disease

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Practicality, safety and accuracy of computed tomography coronary angiography in the evaluation of low TIMI-risk score chest pain patients : A pilot study. / Soon, Kean H.; Kelly, Anne Maree; Cox, Nicholas; MacGregor, Lachlan; Chaitowitz, Ivan; Bell, Kevin; Lim, Yean.

In: EMA - Emergency Medicine Australasia, Vol. 19, No. 2, 04.2007, p. 129-135.

Research output: Contribution to journalArticle

Soon, Kean H. ; Kelly, Anne Maree ; Cox, Nicholas ; MacGregor, Lachlan ; Chaitowitz, Ivan ; Bell, Kevin ; Lim, Yean. / Practicality, safety and accuracy of computed tomography coronary angiography in the evaluation of low TIMI-risk score chest pain patients : A pilot study. In: EMA - Emergency Medicine Australasia. 2007 ; Vol. 19, No. 2. pp. 129-135.
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abstract = "Objectives: The present pilot study aimed to assess the practicality, safety and accuracy of performing CT coronary angiography (CT-CA) in the evaluation of acute chest pain of patients with low thrombolysis in myocardial infarction (TIMI) risk scores. Methods: The present prospective observational study was undertaken in a university teaching hospital between November 2004 and December 2005. Participants were a convenience sample of patients admitted to hospital for investigation of chest pain with TIMI risk scores <3. Consenting patients underwent CT-CA within 48 h of presentation. Outcomes of interest were practicality (proportion of diagnostic quality scans obtained and preparation time for CT-CA), rate of serious adverse events, and accuracy at the patient level using selective coronary angiography as the reference standard. Results: Thirty-four patients were recruited. Diagnostic quality scans were obtained in 26/34 or 76{\%} of patients (four failed CT-CA and four non-diagnostic scans). The median CT preparation time was 1.9 h (range 0.17-4.0). No serious adverse events were found. Fourteen of those 26 patients with diagnostic CT-CA subsequently had selective coronary angiography, of which nine were positive. The sensitivity and specificity of CT-CA in identifying patients with significant coronary artery disease were 9/9 (100{\%}; 95{\%} confidence interval 72-100{\%}) and 4/5 (80{\%}; 95{\%} confidence interval 28-100{\%}), respectively. Conclusions: The majority of acute chest pain patients with low TIMI risk scores were successfully scanned with a 16-slice CT to produce CT-CA studies with good diagnostic quality and accuracy. No major adverse events were found. The place of CT-CA in diagnostic workup for chest pain remains to be defined.",
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AB - Objectives: The present pilot study aimed to assess the practicality, safety and accuracy of performing CT coronary angiography (CT-CA) in the evaluation of acute chest pain of patients with low thrombolysis in myocardial infarction (TIMI) risk scores. Methods: The present prospective observational study was undertaken in a university teaching hospital between November 2004 and December 2005. Participants were a convenience sample of patients admitted to hospital for investigation of chest pain with TIMI risk scores <3. Consenting patients underwent CT-CA within 48 h of presentation. Outcomes of interest were practicality (proportion of diagnostic quality scans obtained and preparation time for CT-CA), rate of serious adverse events, and accuracy at the patient level using selective coronary angiography as the reference standard. Results: Thirty-four patients were recruited. Diagnostic quality scans were obtained in 26/34 or 76% of patients (four failed CT-CA and four non-diagnostic scans). The median CT preparation time was 1.9 h (range 0.17-4.0). No serious adverse events were found. Fourteen of those 26 patients with diagnostic CT-CA subsequently had selective coronary angiography, of which nine were positive. The sensitivity and specificity of CT-CA in identifying patients with significant coronary artery disease were 9/9 (100%; 95% confidence interval 72-100%) and 4/5 (80%; 95% confidence interval 28-100%), respectively. Conclusions: The majority of acute chest pain patients with low TIMI risk scores were successfully scanned with a 16-slice CT to produce CT-CA studies with good diagnostic quality and accuracy. No major adverse events were found. The place of CT-CA in diagnostic workup for chest pain remains to be defined.

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