Early Resting Myocardial Computed Tomography Perfusion for the Detection of Acute Coronary Syndrome in Patients with Coronary Artery Disease

Amit Pursnani, Ashley M. Lee, Thomas Mayrhofer, Waleed Ahmed, Shanmugam Uthamalingam, Maros Ferencik, Stefan B. Puchner, Fabian Bamberg, Christopher L. Schlett, James Udelson, Udo Hoffmann, Brian B. Ghoshhajra

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background-Acute rest single-photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI) has high predictive value for acute coronary syndrome (ACS) in emergency department patients. Prior studies have shown excellent agreement between rest/stress computed tomography perfusion (CTP) and SPECT-MPI, but the value of resting CTP (rCTP) in acute chest pain triage remains unclear. We sought to determine the diagnostic accuracy of early rCTP, incremental value beyond obstructive coronary artery disease (CAD; ≥50% stenosis), and compared early rCTP to late stress SPECT-MPI in patients with CAD presenting with suspicion of ACS to the emergency department. Methods and Results-In this prespecified subanalysis of 183 patients (58.1±10.2 years; 33% women), we included patients with any CAD by coronary computed tomography angiography (CCTA) from Rule Out Myocardial Infarction Using Computer-Assisted Tomography I. rCTP was assessed semiquantitatively, blinded to CAD interpretation. Overall, 31 had ACS and 48 had abnormal rCTP. Sensitivity and specificity of rCTP for ACS were 48% (95% confidence interval [CI], 30%-67%) and 78% (95% CI, 71%-85%), respectively. rCTP predicted ACS (adjusted odds ratio, 3.40 [95% CI, 1.37-8.42]; P=0.008) independently of obstructive CAD, and sensitivity for ACS increased from 77% (95% CI, 59%-90%) for obstructive CAD to 90% (95% CI, 74%-98%) with addition of rCTP (P=0.05). In a subgroup undergoing late rest/stress SPECT-MPI (n=81), CCTA/rCTP had noninferior discriminatory value to CCTA/SPECT-MPI (area under the curve, 0.88 versus 0.90; P=0.64) using a noninferiority margin of 10%. Conclusions-Early rCTP provides incremental value beyond obstructive CAD to detect ACS. CCTA/rCTP is noninferior to CCTA/SPECT-MPI to discriminate ACS and presents an attractive alternative to triage patients presenting with acute chest pain.

Original languageEnglish (US)
Article numbere002404
JournalCirculation: Cardiovascular Imaging
Volume8
Issue number3
DOIs
StatePublished - Mar 21 2015
Externally publishedYes

Fingerprint

Cytidine Triphosphate
Acute Coronary Syndrome
Coronary Artery Disease
Perfusion
Tomography
Myocardial Perfusion Imaging
Confidence Intervals
Single-Photon Emission-Computed Tomography
Triage
Acute Pain
Chest Pain
Hospital Emergency Service
Area Under Curve
Pathologic Constriction
Odds Ratio
Myocardial Infarction
Computed Tomography Angiography

Keywords

  • emergency service hospital
  • perfusion
  • scanners
  • tomography computed

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

Early Resting Myocardial Computed Tomography Perfusion for the Detection of Acute Coronary Syndrome in Patients with Coronary Artery Disease. / Pursnani, Amit; Lee, Ashley M.; Mayrhofer, Thomas; Ahmed, Waleed; Uthamalingam, Shanmugam; Ferencik, Maros; Puchner, Stefan B.; Bamberg, Fabian; Schlett, Christopher L.; Udelson, James; Hoffmann, Udo; Ghoshhajra, Brian B.

In: Circulation: Cardiovascular Imaging, Vol. 8, No. 3, e002404, 21.03.2015.

Research output: Contribution to journalArticle

Pursnani, A, Lee, AM, Mayrhofer, T, Ahmed, W, Uthamalingam, S, Ferencik, M, Puchner, SB, Bamberg, F, Schlett, CL, Udelson, J, Hoffmann, U & Ghoshhajra, BB 2015, 'Early Resting Myocardial Computed Tomography Perfusion for the Detection of Acute Coronary Syndrome in Patients with Coronary Artery Disease', Circulation: Cardiovascular Imaging, vol. 8, no. 3, e002404. https://doi.org/10.1161/CIRCIMAGING.114.002404
Pursnani, Amit ; Lee, Ashley M. ; Mayrhofer, Thomas ; Ahmed, Waleed ; Uthamalingam, Shanmugam ; Ferencik, Maros ; Puchner, Stefan B. ; Bamberg, Fabian ; Schlett, Christopher L. ; Udelson, James ; Hoffmann, Udo ; Ghoshhajra, Brian B. / Early Resting Myocardial Computed Tomography Perfusion for the Detection of Acute Coronary Syndrome in Patients with Coronary Artery Disease. In: Circulation: Cardiovascular Imaging. 2015 ; Vol. 8, No. 3.
@article{6c525aa133354e4296bf7efaf708c676,
title = "Early Resting Myocardial Computed Tomography Perfusion for the Detection of Acute Coronary Syndrome in Patients with Coronary Artery Disease",
abstract = "Background-Acute rest single-photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI) has high predictive value for acute coronary syndrome (ACS) in emergency department patients. Prior studies have shown excellent agreement between rest/stress computed tomography perfusion (CTP) and SPECT-MPI, but the value of resting CTP (rCTP) in acute chest pain triage remains unclear. We sought to determine the diagnostic accuracy of early rCTP, incremental value beyond obstructive coronary artery disease (CAD; ≥50{\%} stenosis), and compared early rCTP to late stress SPECT-MPI in patients with CAD presenting with suspicion of ACS to the emergency department. Methods and Results-In this prespecified subanalysis of 183 patients (58.1±10.2 years; 33{\%} women), we included patients with any CAD by coronary computed tomography angiography (CCTA) from Rule Out Myocardial Infarction Using Computer-Assisted Tomography I. rCTP was assessed semiquantitatively, blinded to CAD interpretation. Overall, 31 had ACS and 48 had abnormal rCTP. Sensitivity and specificity of rCTP for ACS were 48{\%} (95{\%} confidence interval [CI], 30{\%}-67{\%}) and 78{\%} (95{\%} CI, 71{\%}-85{\%}), respectively. rCTP predicted ACS (adjusted odds ratio, 3.40 [95{\%} CI, 1.37-8.42]; P=0.008) independently of obstructive CAD, and sensitivity for ACS increased from 77{\%} (95{\%} CI, 59{\%}-90{\%}) for obstructive CAD to 90{\%} (95{\%} CI, 74{\%}-98{\%}) with addition of rCTP (P=0.05). In a subgroup undergoing late rest/stress SPECT-MPI (n=81), CCTA/rCTP had noninferior discriminatory value to CCTA/SPECT-MPI (area under the curve, 0.88 versus 0.90; P=0.64) using a noninferiority margin of 10{\%}. Conclusions-Early rCTP provides incremental value beyond obstructive CAD to detect ACS. CCTA/rCTP is noninferior to CCTA/SPECT-MPI to discriminate ACS and presents an attractive alternative to triage patients presenting with acute chest pain.",
keywords = "emergency service hospital, perfusion, scanners, tomography computed",
author = "Amit Pursnani and Lee, {Ashley M.} and Thomas Mayrhofer and Waleed Ahmed and Shanmugam Uthamalingam and Maros Ferencik and Puchner, {Stefan B.} and Fabian Bamberg and Schlett, {Christopher L.} and James Udelson and Udo Hoffmann and Ghoshhajra, {Brian B.}",
year = "2015",
month = "3",
day = "21",
doi = "10.1161/CIRCIMAGING.114.002404",
language = "English (US)",
volume = "8",
journal = "Circulation. Cardiovascular imaging",
issn = "1941-9651",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Early Resting Myocardial Computed Tomography Perfusion for the Detection of Acute Coronary Syndrome in Patients with Coronary Artery Disease

AU - Pursnani, Amit

AU - Lee, Ashley M.

AU - Mayrhofer, Thomas

AU - Ahmed, Waleed

AU - Uthamalingam, Shanmugam

AU - Ferencik, Maros

AU - Puchner, Stefan B.

AU - Bamberg, Fabian

AU - Schlett, Christopher L.

AU - Udelson, James

AU - Hoffmann, Udo

AU - Ghoshhajra, Brian B.

PY - 2015/3/21

Y1 - 2015/3/21

N2 - Background-Acute rest single-photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI) has high predictive value for acute coronary syndrome (ACS) in emergency department patients. Prior studies have shown excellent agreement between rest/stress computed tomography perfusion (CTP) and SPECT-MPI, but the value of resting CTP (rCTP) in acute chest pain triage remains unclear. We sought to determine the diagnostic accuracy of early rCTP, incremental value beyond obstructive coronary artery disease (CAD; ≥50% stenosis), and compared early rCTP to late stress SPECT-MPI in patients with CAD presenting with suspicion of ACS to the emergency department. Methods and Results-In this prespecified subanalysis of 183 patients (58.1±10.2 years; 33% women), we included patients with any CAD by coronary computed tomography angiography (CCTA) from Rule Out Myocardial Infarction Using Computer-Assisted Tomography I. rCTP was assessed semiquantitatively, blinded to CAD interpretation. Overall, 31 had ACS and 48 had abnormal rCTP. Sensitivity and specificity of rCTP for ACS were 48% (95% confidence interval [CI], 30%-67%) and 78% (95% CI, 71%-85%), respectively. rCTP predicted ACS (adjusted odds ratio, 3.40 [95% CI, 1.37-8.42]; P=0.008) independently of obstructive CAD, and sensitivity for ACS increased from 77% (95% CI, 59%-90%) for obstructive CAD to 90% (95% CI, 74%-98%) with addition of rCTP (P=0.05). In a subgroup undergoing late rest/stress SPECT-MPI (n=81), CCTA/rCTP had noninferior discriminatory value to CCTA/SPECT-MPI (area under the curve, 0.88 versus 0.90; P=0.64) using a noninferiority margin of 10%. Conclusions-Early rCTP provides incremental value beyond obstructive CAD to detect ACS. CCTA/rCTP is noninferior to CCTA/SPECT-MPI to discriminate ACS and presents an attractive alternative to triage patients presenting with acute chest pain.

AB - Background-Acute rest single-photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI) has high predictive value for acute coronary syndrome (ACS) in emergency department patients. Prior studies have shown excellent agreement between rest/stress computed tomography perfusion (CTP) and SPECT-MPI, but the value of resting CTP (rCTP) in acute chest pain triage remains unclear. We sought to determine the diagnostic accuracy of early rCTP, incremental value beyond obstructive coronary artery disease (CAD; ≥50% stenosis), and compared early rCTP to late stress SPECT-MPI in patients with CAD presenting with suspicion of ACS to the emergency department. Methods and Results-In this prespecified subanalysis of 183 patients (58.1±10.2 years; 33% women), we included patients with any CAD by coronary computed tomography angiography (CCTA) from Rule Out Myocardial Infarction Using Computer-Assisted Tomography I. rCTP was assessed semiquantitatively, blinded to CAD interpretation. Overall, 31 had ACS and 48 had abnormal rCTP. Sensitivity and specificity of rCTP for ACS were 48% (95% confidence interval [CI], 30%-67%) and 78% (95% CI, 71%-85%), respectively. rCTP predicted ACS (adjusted odds ratio, 3.40 [95% CI, 1.37-8.42]; P=0.008) independently of obstructive CAD, and sensitivity for ACS increased from 77% (95% CI, 59%-90%) for obstructive CAD to 90% (95% CI, 74%-98%) with addition of rCTP (P=0.05). In a subgroup undergoing late rest/stress SPECT-MPI (n=81), CCTA/rCTP had noninferior discriminatory value to CCTA/SPECT-MPI (area under the curve, 0.88 versus 0.90; P=0.64) using a noninferiority margin of 10%. Conclusions-Early rCTP provides incremental value beyond obstructive CAD to detect ACS. CCTA/rCTP is noninferior to CCTA/SPECT-MPI to discriminate ACS and presents an attractive alternative to triage patients presenting with acute chest pain.

KW - emergency service hospital

KW - perfusion

KW - scanners

KW - tomography computed

UR - http://www.scopus.com/inward/record.url?scp=84927170450&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84927170450&partnerID=8YFLogxK

U2 - 10.1161/CIRCIMAGING.114.002404

DO - 10.1161/CIRCIMAGING.114.002404

M3 - Article

C2 - 25752898

AN - SCOPUS:84927170450

VL - 8

JO - Circulation. Cardiovascular imaging

JF - Circulation. Cardiovascular imaging

SN - 1941-9651

IS - 3

M1 - e002404

ER -