The Effectiveness of Non ECG Gated Contrast Enhanced Computed Tomography for the Diagnosis of Non ST Segment Elevation Acute Coronary Syndrome.
Non ST segment elevation acute coronary syndrome (NSTE ACS) can be difficult to diagnose accurately, especially in the hyper acute phase. Non ECG gated contrast enhanced computed tomography (non ECG gated CE CT) has been used in many institutions for screening acute chest pain. Although early defects (EDs) observed in non ECG gated CE CT have been reported as a sign of acute myocardial ischemia, the precise diagnostic value of this sign for acute coronary syndrome has not been fully elucidated. We investigated the usefulness of non ECG gated CE CT for the diagnosis of NSTE ACS. We retrospectively reviewed 556 patients who were hospitalized for acute onset chest pain and who underwent emergent coronary angiography. Non ECG gated CE CT was performed in 23 of these patients. Two readers independently analyzed CT images using a 5 point scale. Of the 23 patients, 13 were diagnosed with NSTE ACS. The remaining 10 patients were diagnosed with other conditions. The sensitivity, specificity, positive predictive value, and negative predictive value, respectively, of EDs on non ECG gated CE CT to detect NSTE ACS were 84.6% 90% 91.7% and 81.8% The identification of EDs was consistent between the two readers. Non ECG gated CE CT may be useful not only to triage patients with chest pain by ruling out other conditions, but also to accurately diagnose NSTE ACS.
International heart journal