A Randomized Controlled Trial of Multi-Slice Coronary Computed Tomography for Evaluation of Acute Chest Pain
James A. Goldstein, MD, FACC,
Michael J. Gallagher, MD,
William W. O’Neill, MD, FACC,
Michael A. Ross, MD, FACEP,
Brian J. O’Neil, MD, FACEP and
Gilbert L. Raff, MD, FACC*
William Beaumont Hospital, Royal Oak, Michigan.
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Figure 1 Study Algorithm
In this diagnostic algorithm, patients in the multi-slice computed tomography (MSCT) group with normal scans were eligible for immediate discharge. Patients with severe stenosis on MSCT (over 70%) were referred for invasive angiography, whereas those with intermediate lesions or nondiagnostic scans were referred for nuclear stress scans. Patients in the standard diagnostic group underwent nuclear stress scans and were eligible for discharge if normal or referred for invasive angiography if abnormal. SOC = standard of care diagnostic evaluation.
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Figure 2 MSCT Images From a Patient With Normal Coronary Arteries
Panel A depicts the left anterior descending (LAD) and right coronary arteries (RCA) by volume-rendering technique. Panel B depicts the RCA, and panel C depicts the LAD in maximum intensity projections. MSCT = multi-slice computed tomography.
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Figure 3 Comparative MSCT Images and Invasive Angiograms in a Patient With Severe (>70%) Coronary Stenosis
The appearance of a severe stenosis in the mid-right coronary artery identified by multi-slice computed tomography (MSCT) (A, arrow) is concordant with the appearance on invasive angiography (B, arrow).
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