Coronary computed tomography angiography for early triage of patients with acute chest pain: the ROMICAT (Rule Out Myocardial Infarction using Computer Assisted Tomography) trial.
Coronary computed tomography angiography for early triage of patients with acute chest pain: the ROMICAT (Rule Out Myocardial Infarction using Computer Assisted Tomography) trial.
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DOI：
10.1016/j.jacc.2009.01.052
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发表时间：
2009-05-05
影响因子：
24
通讯作者：
Nagurney, John T.
中科院分区：
文献类型：
--
作者：
Hoffmann, Udo;Bamberg, Fabian;Chae, Claudia U.;Nichols, John H.;Rogers, Ian S.;Seneviratne, Sujith K.;Truong, Quynh A.;Cury, Ricardo C.;Abbara, Suhny;Shapiro, Michael D.;Moloo, Jamaluddin;Butler, Javed;Ferencik, Maros;Lee, Hang;Jang, Ik-Kyung;Parry, Blair A.;Brown, David F.;Udelson, James E.;Achenbach, Stephan;Brady, Thomas J.;Nagurney, John T.
确定冠状动脉计算机断层扫描血管造影术（CTA）在急性胸痛患者中的有效性。急诊科（艾德）胸痛患者的分诊仍然具有挑战性。在初始肌钙蛋白正常和非缺血性心电图的胸痛患者中进行的观察性队列研究。64-在入院前进行切片冠状动脉CTA以检测冠状动脉斑块和狭窄（>50%管腔狭窄）。结果没有公布。终点为首次住院期间的急性冠脉综合征（ACS）和6个月随访期间的主要不良心脏事件（MACE）。在368例患者中（平均年龄53±12岁，61%为男性），31例（8%）患有ACS。通过冠状动脉CTA，这些患者中有50%没有CAD，31%有非阻塞性疾病，19%的CT不确定或阳性明显狭窄。ACS的敏感性和阴性预测值（NPV）均为100%（n=183/368; 95%置信区间[CI]：98 - 100%）和100%（95%-CI：0.89-1.00）无CAD; 77%（95% CI：59-90%）和98%（n=300/368，95%-CI：95-99%）冠状动脉CTA显示显著狭窄。斑块和狭窄对ACS的特异性分别为54%（95%-CI：0.49-0.60）和87%（95%-CI：0.83-0.90）。只有一个ACS发生在没有钙化斑块。冠状动脉斑块的程度和狭窄的存在都是ACS的独立预测因素，并且随着TIMI风险评分的增加而增加（AUC分别为0.88、0.82和0.63，均p<0.0001）。50%的急性胸痛和低至中等可能性ACS的患者通过CT检查没有CAD，也没有ACS。鉴于此类患者数量众多，早期冠状动脉CTA可能会显著改善急诊科的患者管理。
To determine the usefulness of coronary computed tomography angiography (CTA) in patients with acute chest pain. Triage of chest pain patients in the emergency department (ED) remains challenging. Observational cohort study in chest pain patients with normal initial troponin and non-ischemic electrocardiogram. 64-slice coronary CTA was performed prior to admission to detect coronary plaque and stenosis (>50% luminal narrowing). Results were not disclosed. Endpoints were acute coronary syndrome (ACS) during index hospitalization and major adverse cardiac events (MACE) during 6- month follow-up. Among 368 patients (mean age 53±12 years, 61% male) 31 had ACS (8%). By coronary CTA, 50% of these patients were free of CAD, 31% had nonobstructive disease, and 19% had inconclusive or positive CT for significant stenosis. Sensitivity and negative predictive value (NPV) for ACS were 100% (n=183/368; 95% confidence interval [CI]: 98 to 100%) and 100% (95%-CI: 0.89–1.00) with the absence of CAD; and 77% (95% CI: 59–90%) and 98% (n=300/368, 95%-CI: 95–99%) with significant stenosis by coronary CTA. Specificity of presence of plaque and stenosis for ACS were 54% (95%-CI: 0.49–0.60) and 87% (95%-CI: 0.83–0.90); respectively. Only one ACS occurred in the absence of calcified plaque. Both, the extent of coronary plaque and presence of stenosis predicted ACS independently and incrementally to TIMI risk score (AUC: 0.88, 0.82 vs. 0.63; respectively, all p<0.0001). Fifty percent of patients with acute chest pain and low to intermediate likelihood of ACS are free of CAD by CT and have no ACS. Given the large number of such patients early coronary CTA may significantly improve patient management in the emergency department.
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影响因子：
4.4
作者：
Hollander, Judd E.;Litt, Harold I.;Baxt, William G.
通讯作者：
Baxt, William G.
影响因子：
2.8
作者：
LEE, TH;ROUAN, GW;GOLDMAN, L
通讯作者：
GOLDMAN, L
DOI：
10.1097/01.rct.0000151188.72850.0d
发表时间：
2005-01-01
影响因子：
1.3
作者：
Hundt, W;Rust, F;Reiser, M
通讯作者：
Reiser, M
DOI：
10.1016/s0735-1097(99)00231-4
发表时间：
1999-08-01
影响因子：
24
作者：
Fragasso, G;Lu, CZ;Chierchia, SL
通讯作者：
Chierchia, SL
影响因子：
37.8
作者：
Gibler, WB;Cannon, CP;Pollack, CV
通讯作者：
Pollack, CV