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Published on: August 28, 2018
Utilization of Non-Gated Chest Computed Tomography Scans in Predicting Acute Coronary Occlusion in Out-of-Hospital
Ahmad Jabri1, Laith Alhuneafat2, Pejman Raeisi-Giglou1
1Heart and Vascular Institute, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH.
Insights
Computed Tomography (CT) chest scans showing myocardial perfusion defects have limited utility in predicting acute coronary occlusion in out-of-hospital cardiac arrest patients. Further research is needed to explore contrast-enhanced CT
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Coronary artery disease (CAD) is a leading cause of out-of-hospital cardiac arrest (OHCA).
- Identifying acute coronary occlusion as the cause of OHCA is critical for guiding treatment.
- The diagnostic value of chest Computed Tomography (CT) for acute coronary occlusion in OHCA patients is not well-established.
Purpose of the Study:
- To evaluate the utility of myocardial perfusion defects on contrast-enhanced chest CT in predicting acute coronary occlusion in OHCA patients.
- To determine if the absence of a perfusion defect on CT can exclude an ischemic etiology for cardiac arrest.
Main Methods:
- Retrospective cohort study of 53 patients with Ventricular Tachycardia (VT) or Ventricular Fibrillation (VF) arrest and successful resuscitation.
- Contrast-enhanced chest CT scans performed before coronary angiography were reviewed for myocardial perfusion defects by blinded cardiologists and radiologists.
- CT findings were compared with coronary angiography results.
Main Results:
- 42% of patients had critical stenosis on coronary angiography.
- Sensitivity of CT perfusion defects for detecting critical stenosis was 45% (95% CI [0.24, 0.68]).
- Specificity was 77% (95% CI [59%, 90%]), with a diagnostic accuracy of 64.2%.
Conclusions:
- Myocardial perfusion defects on incidental contrast-enhanced chest CT have limited utility in predicting acute thrombotic occlusion in OHCA patients.
- The study did not demonstrate significant value in using CT perfusion defects to identify the cause of cardiac arrest.
- Further studies are warranted to investigate the role of contrast-enhanced CT in predicting acute coronary occlusion.
Abstract:
Coronary artery disease is thought to be responsible for up to 60%-80% of out-of-hospital cardiac arrests. The utility of Computed Tomography (CT) chest when it comes to identifying acute coronary occlusion in patients following an arrest has not been studied. We evaluated whether myocardial perfusion on a contrast-enhanced chest CT performed for a non-cardiac cause can predict culprit coronary occlusion as the cause of cardiac arrest and if the absence of a perfusion defect can exclude an ischemic etiology. A retrospective cohort of 53 consecutive patients presenting with VT or VF arrest and successful resuscitation who had contrast chest CT before angiography were identified. CT scans were reviewed for myocardial perfusion defects by a cardiologist and radiologist blinded to angiogram findings. CT results were then compared with angiograms. On coronary angiography, 22 (42%) of the patients presenting with out-of-hospital arrest had critical stenosis. Sensitivity and specificity of perfusion defect on CT in identifying critical stenosis on catheterization was 0.45, 95% CI [0.24, 0.68] and 0.77, 95% CI [59%, 90%], respectively. The positive likelihood ratio was 2.01 (0.91, 4.46) and the negative likelihood ratio was 0.70 (0.46, 1.08). The diagnostic accuracy was 64.2%. Our study did not show much utility for the use of myocardial perfusion defect on an incidental pre-angiography contrast chest CT to predict acute thrombotic occlusion in out-of-hospital cardiac arrest patients. However, this shouldn't discourage further studies evaluating the utility of contrast-enhanced CT images in predicting acute coronary occlusion.
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