Efficacy of multi-detector coronary computed tomography angiography in comparison with exercise electrocardiogram in the triage of patients of low risk acute chest pain

Abstract

Objectives: To compare the safety and diagnostic efficacy of coronary computed tomography angiography (CTA) with exercise electrocardiography (XECG) in triaging patients of low risk acute chest pain.

Background: Noninvasive assessment of coronary stenosis by CTA may improve early and accurate triage of patients presenting with acute chest pain to the emergency department (ED).

Methods: Low risk patients of possible acute coronary syndrome (ACS) were included in the study. The patients in CTA arm with significant stenosis (≥ 50%) underwent catheterization, while those with no or intermediate stenosis (<50%) were discharged from ED and followed up periodically for six months for major adverse cardiovascular events (MACE). The same protocol was applied for XECG arm. Outcomes included: safety and diagnostic efficacy.

Results: A total of 81 (41 CTA and 40 XECG) patients were enrolled. In this study CTA was observed to be 100% sensitive and 95.7% specific in diagnosing MACE in low risk patients of chest pain presenting to the ED, with a PPV of 94.7% and an NPV of 100%.The overall diagnostic efficacy was 97.6%. XECG was observed to be 72.7% sensitive and 96.6% specific in diagnosing MACE with a PPV of 88.9% and NPV of 90.3% in low risk chest pain patients presenting to the ED. The overall diagnostic accuracy was 90%.

Conclusion: CTA is an excellent diagnostic tool in ED patients with low risk of ACS, with minimum time delay as compared to XECG, and also is safe for triaging such patients.

Keywords: CT coronary angiography; Chest pain; Emergency department; Exercise electrocardiogram.