Cardiac Applications for Multi-Detector Row CT in the Emergency Department

摘要

Although more than 6 million patients present with acute chest pain to emergency departments in the United States each year and roughly a third of them are admitted to the hospital, only a fraction (approx 10%) are subsequently diagnosed with acute coronary syndrome. This practice can be attributed to the low sensitivity of early biomarkers (troponin) and changes in the electrocardiogram (ECG) for acute coronary syndrome. In addition, missed acute myocardial infarctions are still responsible for 20% of emergency department malpractice dollar losses (1,2), and the number of missed myocardial infarctions remains relatively high (1%-3%), albeit decreased from approximately 6% many years ago (1,3,4). Despite the fact that significant coronary artery disease (>50% coronary stenosis) is the leading cause of acute coronary syndrome (90%) in patients with acute chest pain, current strategies to diagnose acute coronary syndrome in the emergency department do not include morphologic information on the presence and severity of coronary artery disease. Although cardiac multi-detector row computed tomography (CT) is not a part of the usual clinical care in patients with chest pain, it is conceivable that the fast and noninvasive detection of the presence or absence of significant coronary artery stenosis constitutes an attractive approach to substantially improve the clinical care of patients with acute chest pain.