Cardiac computed tomographic angiography in patients with acute chest pain and moderately-increased troponin

Area of Science:

• Cardiology
• Radiology
• Emergency Medicine

Background:

• Chest pain is a common presentation in emergency departments.
• Elevated troponin levels in conjunction with chest pain suggest potential acute coronary syndrome.
• Accurate and timely diagnosis is crucial for effective patient management.

Purpose of the Study:

• To evaluate the utility of cardiac computed tomographic angiography (CCTA) in patients presenting with undefined chest pain and moderately elevated troponin.
• To determine if CCTA can accurately identify or exclude significant coronary artery stenosis in this patient cohort.
• To assess the role of CCTA in detecting alternative diagnoses in patients with acute chest pain.

Main Methods:

• Retrospective analysis of 43 patients with acute chest pain and moderately increased troponin who underwent CCTA.
• Patients with suspected stenosis on CCTA proceeded to percutaneous coronary angiography (PCA) for confirmation.
• A subset of patients underwent a triple-rule-out CT protocol to assess for pulmonary embolism and pericardial effusion.

Main Results:

• CCTA successfully ruled out significant coronary stenosis in 32 patients.
• Eleven patients showed suspected stenosis on CCTA; nine were confirmed to have significant coronary lesions via PCA.
• Four patients received percutaneous coronary intervention (PCI), and one required coronary artery bypass grafting.
• The triple-rule-out protocol identified pulmonary embolism in three patients and pericardial effusion in two.

Conclusions:

• CCTA is a valuable tool for accurately diagnosing or excluding coronary artery disease in patients with chest pain and moderately elevated troponin.
• CCTA findings guide the need for invasive procedures like PCA.
• CCTA can also identify other critical non-coronary thoracic pathologies, improving diagnostic yield.