Acute coronary syndrome on non-electrocardiogram-gated contrast-enhanced computed tomography

It is not rare for acute coronary syndrome (ACS) patients to present with symptoms that are atypical, rather than chest pain. It is sometimes difficult to achieve a definitive diagnosis of ACS for such patients who present with atypical symptoms, normal initial biomarkers of myocardial necrosis, and normal or nondiagnostic electrocardiograms (ECGs). Although cardiac CT allows for assessments of coronary artery stenosis as well as myocardial perfusion defect in patients with suspected ACS, it requires ECG gating and is usually performed with high-performance multislice CT for highly probable ACS patients. However, several recent reports have stated that ACS is detectable by myocardial perfusion defects even on routine non-ECG-gated contrast-enhanced CT. A growing number of contrast-enhanced CT scans are now being performed in emergency departments in search of pathologies responsible for a patient's presenting symptoms. In order to avoid inappropriate management for this life-threatening event, clinicians should be aware that myocardial perfusion defect is more commonly detectable even on routine non-ECG-gated contrast-enhanced CT performed in search of other pathologies.