This article is more than 5 years old. Information may no longer be current.
ROMICAT: In patients with chest pain, coronary CTA can rule out CAD
Click Here to Manage Email Alerts
Coronary CTA ruled coronary artery disease in 50% of patients with acute chest pain and a low to intermediate likelihood of acute coronary syndromes.
Researchers enrolled 368 patients with normal initial troponin and nonischemic electrocardiograms in the study and assigned each to undergo a 64-slice coronary CTA. The researchers established a clinical endpoint of ACS, consisting of either acute MI or unstable angina pectoris. Major adverse cardiac events during follow-up were monitored.
According to the study results, 31 (8%) of the patients had ACS, and CTA ruled out ACS in the remaining 337 patients. The researchers reported that 183 (50.3%) of the patients with ACS were free of CAD, 117 (31.2%) had plaque but no stenosis, and 68 (18.5%) of the patients had a positive CTA. The sensitivity and negative predictive value was reported to be 100%, but the positive predictive value (17%) and the specificity for the detection of any plaque (54%) were lower. After logistical regression analysis, each additional segment of plaque was associated with a 37% increase in risk for ACS (OR=1.37; 95% CI, 1.25-1.51). The presence of stenosis was associated with a 20-fold increased risk for ACS (OR=22.8; 95% CI, 9.3-56.1).
“Both plaque and stenosis by CT predict ACS independent of CV risk factors or TIMI risk score. In this study, 50% of patients with acute chest pain and low to intermediate likelihood of ACS are free of CAD by CT and have no ACS,” the researchers concluded. “Given the large number of such patients, early coronary CTA may significantly improve patients’ management in the ED.” - by Eric Raible
Hoffmann U. J Am Coll Cardiol. 2009;53:1642-1650.
