Reliability of coronary computed tomography angiography in acute coronary syndrome in an emergency setting

Sergey Ternovoy; Dmitry Ustyuzhanin; Merab Shariya; Maria Shabanova; Svetlana Gaman; Natalya Serova; Vsevolod Mironov; Irina Merkulova; Anna Rienmueller; Elias Laurin Meyer; Theresa Rienmueler

doi:10.1016/j.heliyon.2021.e06075

Reliability of coronary computed tomography angiography in acute coronary syndrome in an emergency setting

Heliyon. 2021 Feb 1;7(2):e06075. doi: 10.1016/j.heliyon.2021.e06075. eCollection 2021 Feb.

Authors

Affiliations

¹ Sechenov First Moscow State Medical University (Sechenov University), 6-1 Bolshaya Pirogovskaya st., 119435 Moscow, Russian Federation.
² National Medical Research Center of Cardiology, 15а 3-rd Cherepkovskaya st., 121552, Moscow, Russian Federation.
³ Department of Orthopedic Surgery, Medical University Vienna General Hospital, Währinger Gürtel 18-20, 1090 Vienna, Austria.
⁴ Section for Medical Statistics, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University Vienna, Spitalgasse 23, BT88/E 03, 1090 Vienna, Austria.
⁵ Institute of Health Care Engineering, Graz University of Technology, Stremayrgasse 16/II, 8010 Graz, Austria.

Abstract

Background: Cardiovascular computed tomography (cardiovascular CT) is currently used as a fast non-invasive method for the visualization of coronary plaques and walls and the assessment of lumen stenosis severity. Previous studies demonstrated the high negative predictive value of CT for the exclusion of coronary lumen stenoses. In this study we hypothesize that coronary CT angiography (CTA) represents a reliable method as diagnostic procedure in acute coronary syndrome (ACS) even in emergency settings.

Methods: 36 patients (51 lesions) with ACS who underwent cardiovascular CT, intravascular ultrasound (IVUS) and invasive coronary angiography (ICA) within 48 h were included. The percentage of coronary stenoses were measured and compared by three methods. Influence of available predictors that can potentially affect the measurement results was assessed.

Results: Cardiac CTA provided comparable results to IVUS (mean difference -0.45%, PPV: 98%, NPV: 75%). ICA tends to estimate lower stenoses degrees than cardiac CTA and IVUS (mean difference 13.19% and 13.64%, respectively). The final diagnosis and positive remodeling did not lead to any significant influence on measurements.

Conclusions: The cardiovascular CT results show that even in emergency settings it is possible to identify morphological changes as sequels of coronary artery sclerosis with comparable results to the reference method IVUS. Deviations of IVUS and cardiovascular CT from ICA are comparable and can to a large extent be explained by differences in the measurement technique.

Keywords: Acute coronary syndrome; Coronary angiography; Coronary atherosclerosis; Coronary computed tomography; Coronary stenosis; Intravascular ultrasound.