A study attempting to determine the benefits of multidetector CT angiography in evaluating chest pain in the emergency department concluded that the tool demonstrates good sensitivity, specificity, and negative predictive value for the diagnosis of acute coronary syndrome (ACS).

The results of the work led by Charles White, MD, from the University of Maryland, Baltimore, were presented on Sunday at the Radiological Society of North America's 2007 Annual Meeting in Chicago. A prospective cohort study of subjects presenting to the ED with acute chest pain was undertaken from January 2006 through January 2007 at a single urban university tertiary referral center.

CT scans were acquired with a 64-detector CT scanner with administration of iodinated contrast and retrospective ECG gating.

A triple rule-out protocol enabled assessment of non-cardiac causes of chest pain. Significant stenosis was defined as >50 per cent (scenario 1) or >70 per cent (scenario 2). All patients also underwent image-based stress testing. One hundred subjects (50 men and 50 women) took part in the study.

Myocardial perfusion imaging was obtained in 67 patients, stress echocardiography in 24, and both studies in nine.

For scenario 1 (>50 per cent stenosis), sensitivity was 100 per cent and specificity was 91 per cent for the final diagnosis of ACS. Positive and negative predictive values were 10 and 100 per cent, respectively. Positive likelihood ratio was 11.1. For scenario 2 (>70 per cent stenosis), sensitivity was 100 per cent and specificity was 98 per cent for the final diagnosis of ACS.

Positive and negative predictive values were 33.3 and 100 per cent, respectively. Positive likelihood ratio was 50.

"MDCTA shows promise in expediting and improving ED triage of patients presenting with chest pain", said Dr. White, affirming the method could potentially reduce the number of these patients who are hospitalized or discharged inappropriately.

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