Coronary Computed Tomography Angiography for Early Triage of Patients With Acute Chest Pain The ROMICAT (Rule Out Myocardial Infarction using Computer Assisted Tomography) Trial

被引：388

作者：

Hoffmann, Udo ^{[1
,2
,6
]}

Bamberg, Fabian ^{[1
,2
]}

Chae, Claudia U. ^{[3
]}

Nichols, John H. ^{[1
]}

Rogers, Ian S. ^{[1
]}

Seneviratne, Sujith K. ^{[1
]}

Truong, Quynh A. ^{[1
]}

Cury, Ricardo C. ^{[1
,2
]}

Abbara, Suhny ^{[1
,2
]}

Shapiro, Michael D. ^{[1
]}

Moloo, Jamaluddin ^{[1
]}

Butler, Javed ^{[1
]}

Ferencik, Maros ^{[1
]}

Lee, Hang ^{[4
]}

Jang, Ik-Kyung ^{[3
]}

Parry, Blair A. ^{[5
]}

Brown, David F. ^{[5
]}

Udelson, James E. ^{[7
,8
]}

Achenbach, Stephan ^{[9
]}

Brady, Thomas J. ^{[1
,2
]}

Nagurney, John T. ^{[5
]}

机构：

[1] Massachusetts Gen Hosp, Cardiac MR PET CT Program, Boston, MA 02114 USA

[2] Massachusetts Gen Hosp, Dept Radiol, Boston, MA 02114 USA

[3] Massachusetts Gen Hosp, Div Cardiol, Boston, MA 02114 USA

[4] Massachusetts Gen Hosp, Ctr Biostat, Boston, MA 02114 USA

[5] Massachusetts Gen Hosp, Dept Emergency Med, Boston, MA 02114 USA

[6] Harvard Univ, Sch Med, Boston, MA USA

[7] Tufts Med Ctr, Div Cardiol, Boston, MA USA

[8] Tufts Univ, Sch Med, Boston, MA 02111 USA

[9] Univ Erlangen Nurnberg, Dept Cardiol, Erlangen, Germany

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2009年 / 53卷 / 18期

基金：

美国国家卫生研究院;

关键词：

cardiac CT; emergency department; acute chest pain; EMERGENCY-DEPARTMENT PATIENTS; ACUTE CARDIAC ISCHEMIA; ARTERY-DISEASE; PRACTICAL IMPLEMENTATION; INTRAVASCULAR ULTRASOUND; RISK STRATIFICATION; PROGNOSTIC VALUE; UNSTABLE ANGINA; PERFUSION; GUIDELINES;

D O I：

10.1016/j.jacc.2009.01.052

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives This study was designed to determine the usefulness of coronary computed tomography angiography (CTA) in patients with acute chest pain. Background Triage of chest pain patients in the emergency department remains challenging. Methods We used an observational cohort study in chest pain patients with normal initial troponin and nonischemic electrocardiogram. A 64-slice coronary CTA was performed before admission to detect coronary plaque and stenosis (> 50% luminal narrowing). Results were not disclosed. End points were acute coronary syndrome (ACS) during index hospitalization and major adverse cardiac events during 6-month follow-up. Results Among 368 patients (mean age 53 +/- 12 years, 61% men), 31 had ACS (8%). By coronary CTA, 50% of these patients were free of coronary artery disease (CAD), 31% had nonobstructive disease, and 19% had inconclusive or positive computed tomography for significant stenosis. Sensitivity and negative predictive value for ACS were 100% (n = 183 of 368; 95% confidence interval [CI]: 98% to 100%) and 100% ( 95% CI: 89% to 100%), respectively, with the absence of CAD and 77% (95% CI: 59% to 90%) and 98% ( n = 300 of 368, 95% CI: 95% to 99%), respectively, with significant stenosis by coronary CTA. Specificity of presence of plaque and stenosis for ACS were 54% ( 95% CI: 49% to 60%) and 87% (95% CI: 83% to 90%), respectively. Only 1 ACS occurred in the absence of calcified plaque. Both the extent of coronary plaque and presence of stenosis predicted ACS independently and incrementally to Thrombolysis In Myocardial Infarction risk score (area under curve: 0.88, 0.82, vs. 0.63, respectively; all p < 0.0001). Conclusions Fifty percent of patients with acute chest pain and low to intermediate likelihood of ACS were free of CAD by computed tomography and had no ACS. Given the large number of such patients, early coronary CTA may significantly improve patient management in the emergency department. (J Am Coll Cardiol 2009; 53: 1642-50) (C) 2009 by the American College of Cardiology Foundation

引用

页码：1642 / 1650

页数：9

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