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Diagnostic Accuracy and Clinical Outcomes of ECG-Gated, Whole Chest CT in the Emergency Department

PURPOSE: The purpose of this study was to assess the diagnostic accuracy and one year prognosis of whole chest, “multiple rule out” CT for coronary artery disease (CAD) in Emergency Department patients. METHODS AND FINDINGS: One hundred and two Emergency Department patients at low to intermediate ri...

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Autores principales: Branch, Kelley R., Strote, Jared, Shuman, William P., Mitsumori, Lee M., Busey, Janet M., Rue, Tessa, Caldwell, James H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3629052/
https://www.ncbi.nlm.nih.gov/pubmed/23613797
http://dx.doi.org/10.1371/journal.pone.0061121
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author Branch, Kelley R.
Strote, Jared
Shuman, William P.
Mitsumori, Lee M.
Busey, Janet M.
Rue, Tessa
Caldwell, James H.
author_facet Branch, Kelley R.
Strote, Jared
Shuman, William P.
Mitsumori, Lee M.
Busey, Janet M.
Rue, Tessa
Caldwell, James H.
author_sort Branch, Kelley R.
collection PubMed
description PURPOSE: The purpose of this study was to assess the diagnostic accuracy and one year prognosis of whole chest, “multiple rule out” CT for coronary artery disease (CAD) in Emergency Department patients. METHODS AND FINDINGS: One hundred and two Emergency Department patients at low to intermediate risk of acute coronary syndrome (ACS), pulmonary embolism and/or acute aortic syndrome underwent a research 64 channel ECG-gated, whole chest CT and a standard of care evaluation. Patients were classified with obstructive CAD with either a coronary CT stenosis greater than 50% or a non-evaluable coronary segment. SOC and 3 month follow up data were used to determine an adjudicated clinical diagnosis. The diagnostic ability of obstructive CAD on CT to identify clinical diagnoses was determined. Patients were followed up for 1 year for cardiac events. Seven (7%) patients were diagnosed with ACS. CT sensitivity to detect obstructive CAD in ACS patients was 100% (95% CI 65%, 100%), negative predictive value 100% (96%, 100%), specificity 88% (80%, 94%), and positive predictive value 39% (17%, 64%). Pulmonary embolism and acute aortic syndrome were not identified in any patients. No cardiac events occurred in patients without obstructive CAD over 1 year. CONCLUSIONS: Whole chest CT has high sensitivity and negative predictive value for ACS with excellent one year prognosis in patients without obstructive CAD on CT. The frequency of pulmonary embolism or acute aortic syndrome and the higher radiation dose suggest whole chest CT should be limited to select patients. ClinicalTrials.org #: NCT00855231
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spelling pubmed-36290522013-04-23 Diagnostic Accuracy and Clinical Outcomes of ECG-Gated, Whole Chest CT in the Emergency Department Branch, Kelley R. Strote, Jared Shuman, William P. Mitsumori, Lee M. Busey, Janet M. Rue, Tessa Caldwell, James H. PLoS One Research Article PURPOSE: The purpose of this study was to assess the diagnostic accuracy and one year prognosis of whole chest, “multiple rule out” CT for coronary artery disease (CAD) in Emergency Department patients. METHODS AND FINDINGS: One hundred and two Emergency Department patients at low to intermediate risk of acute coronary syndrome (ACS), pulmonary embolism and/or acute aortic syndrome underwent a research 64 channel ECG-gated, whole chest CT and a standard of care evaluation. Patients were classified with obstructive CAD with either a coronary CT stenosis greater than 50% or a non-evaluable coronary segment. SOC and 3 month follow up data were used to determine an adjudicated clinical diagnosis. The diagnostic ability of obstructive CAD on CT to identify clinical diagnoses was determined. Patients were followed up for 1 year for cardiac events. Seven (7%) patients were diagnosed with ACS. CT sensitivity to detect obstructive CAD in ACS patients was 100% (95% CI 65%, 100%), negative predictive value 100% (96%, 100%), specificity 88% (80%, 94%), and positive predictive value 39% (17%, 64%). Pulmonary embolism and acute aortic syndrome were not identified in any patients. No cardiac events occurred in patients without obstructive CAD over 1 year. CONCLUSIONS: Whole chest CT has high sensitivity and negative predictive value for ACS with excellent one year prognosis in patients without obstructive CAD on CT. The frequency of pulmonary embolism or acute aortic syndrome and the higher radiation dose suggest whole chest CT should be limited to select patients. ClinicalTrials.org #: NCT00855231 Public Library of Science 2013-04-16 /pmc/articles/PMC3629052/ /pubmed/23613797 http://dx.doi.org/10.1371/journal.pone.0061121 Text en © 2013 Branch et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Branch, Kelley R.
Strote, Jared
Shuman, William P.
Mitsumori, Lee M.
Busey, Janet M.
Rue, Tessa
Caldwell, James H.
Diagnostic Accuracy and Clinical Outcomes of ECG-Gated, Whole Chest CT in the Emergency Department
title Diagnostic Accuracy and Clinical Outcomes of ECG-Gated, Whole Chest CT in the Emergency Department
title_full Diagnostic Accuracy and Clinical Outcomes of ECG-Gated, Whole Chest CT in the Emergency Department
title_fullStr Diagnostic Accuracy and Clinical Outcomes of ECG-Gated, Whole Chest CT in the Emergency Department
title_full_unstemmed Diagnostic Accuracy and Clinical Outcomes of ECG-Gated, Whole Chest CT in the Emergency Department
title_short Diagnostic Accuracy and Clinical Outcomes of ECG-Gated, Whole Chest CT in the Emergency Department
title_sort diagnostic accuracy and clinical outcomes of ecg-gated, whole chest ct in the emergency department
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3629052/
https://www.ncbi.nlm.nih.gov/pubmed/23613797
http://dx.doi.org/10.1371/journal.pone.0061121
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