A Computed Tomography-Based Coronary Lesion Score to Predict Acute Coronary Syndrome Among Patients With Acute Chest Pain and Significant Coronary Stenosis on Coronary Computed Tomographic Angiogram - 23/06/12
, Christopher L. Schlett, MD, MPH b, c, Brian B. Ghoshhajra, MD, MBA b, c, Mathias F. Kriegel b, c, Subodh B. Joshi, MD b, c, Pal Maurovich-Horvat, MD b, c, Ian S. Rogers, MD, MBA b, c, Dahlia Banerji, MD b, c, Fabian Bamberg, MD, MPH b, c, e, Quynh A. Truong, MD, MPH a, b, c, Thomas J. Brady, MD b, c, John T. Nagurney, MD, MPH d, Udo Hoffmann, MD, MPH b, c
Corresponding author: Tel: 617-724-8944; fax: 617-724-4152Résumé |
We tested the hypothesis that morphologic lesion assessment helps detect acute coronary syndrome (ACS) during index hospitalization in patients with acute chest pain and significant stenosis on coronary computed tomographic angiogram (CTA). Patients who presented to an emergency department with chest pain but no objective signs of myocardial ischemia (nondiagnostic electrocardiogram and negative initial biomarkers) underwent CT angiography. CTA was analyzed for degree and length of stenosis, plaque area and volume, remodeling index, CT attenuation of plaque, and spotty calcium in all patients with significant stenosis (>50% in diameter) on CTA. ACS during index hospitalization was determined by a panel of 2 physicians blinded to results of CT angiography. For lesion characteristics associated with ACS, we determined cutpoints optimized for diagnostic accuracy and created lesion scores. For each score, we determined the odds ratio (OR) and discriminatory capacity for the prediction of ACS. Of the overall population of 368 patients, 34 had significant stenosis and 21 of those had ACS. Scores A (remodeling index plus spotty calcium: OR 3.5, 95% confidence interval [CI] 1.2 to 10.1, area under curve [AUC] 0.734), B (remodeling index plus spotty calcium plus stenosis length: OR 4.6, 95% CI 1.6 to 13.7, AUC 0.824), and C (remodeling index plus spotty calcium plus stenosis length plus plaque volume <90 HU: OR 3.4, 95% CI 1.5 to 7.9, AUC 0.833) were significantly associated with ACS. In conclusion, in patients presenting with acute chest pain and stenosis on coronary CTA, a CT-based score incorporating morphologic characteristics of coronary lesions had a good discriminatory value for detection of ACS during index hospitalization.
Le texte complet de cet article est disponible en PDF.Plan
| This work was supported by Grant RO1 HL080053 from the National Institutes of Health, Bethesda, Maryland and supported in part by Siemens Medical Solutions, Forchheim, Germany and General Electric Healthcare, Princeton, New Jersey. Dr. Ferencik, Dr. Rogers, Dr. Truong, and Dr. Ghoshhajra were supported by Grant T32 HL076136 from the National Institutes of Health. Dr. Hoffmann has received research grants from Siemens Medical Solutions and General Electric Healthcare. Dr. Nagurney is funded by Biosite, San Diego, California for a biomarker research study. |
Vol 110 - N° 2
P. 183-189 - juillet 2012 Retour au numéro
Article précédent
- Practices and Complications of Vascular Closure Devices and Manual Compression in Patients Undergoing Elective Transfemoral Coronary Procedures
- Nathaniel R. Smilowitz, Ajay J. Kirtane, Michael Guiry, William A. Gray, Pilar Dolcimascolo, Michael Querijero, Claudia Echeverry, Nellie Kalcheva, Braulio Flores, Varinder P. Singh, LeRoy Rabbani, Susheel Kodali, Michael B. Collins, Martin B. Leon, Jeffrey W. Moses, Giora Weisz
- Usefulness of Lung Impedance-Guided Pre-Emptive Therapy to Prevent Pulmonary Edema During ST-Elevation Myocardial Infarction and to Improve Long-Term Outcomes
- Michael Shochat, Avraham Shotan, David S. Blondheim, Mark Kazatsker, Iris Dahan, Aya Asif, Ilia Shochat, Paul Rabinovich, Yoseph Rozenman, Simcha R. Meisel
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?