Evaluation of the patient with acute chest pain.

The past decade has brought rapid advances in CT technology, which allows increasingly precise application to the study of coronary arteries and acute chest pain. The literature has expanded to lend quantifiable justification to the intuitive appeal of a rapid, reproducible, 3D study of the heart and vasculature. More complete analysis of efficacy and costs on broader populations will further refine our understanding of how best to implement what may become the new gold standard. Meanwhile, evolving technology promises to further challenge radiologists and clinicians to optimize approach and diagnosis to acute chest pain.

[1]  L. Goldman,et al.  Care of patients with a low probability of acute myocardial infarction. Cost effectiveness of alternatives to coronary-care-unit admission. , 1984, The New England journal of medicine.

[2]  R. Virmani,et al.  Coronary calcification: insights from sudden coronary death victims , 2000, Zeitschrift für Kardiologie.

[3]  C. Roobottom,et al.  Multi-detector row computed tomography: imaging in acute aortic syndrome. , 2005, Clinical radiology.

[4]  B. Lewis,et al.  Impact of 64-slice cardiac computed tomographic angiography on clinical decision-making in emergency department patients with chest pain of possible myocardial ischemic origin. , 2007, The American journal of cardiology.

[5]  S. Shim,et al.  Improvement of image quality with beta-blocker premedication on ECG-gated 16-MDCT coronary angiography. , 2005, AJR. American journal of roentgenology.

[6]  W. Bautz,et al.  Detection of Coronary Artery Stenoses With Thin-Slice Multi-Detector Row Spiral Computed Tomography and Multiplanar Reconstruction , 2003, Circulation.

[7]  L. Wallentin.  Non-ST-elevation acute coronary syndrome: fuel for the invasive strategy , 2002, The Lancet.

[8]  Masao Kiguchi,et al.  Prospective versus retrospective ECG-gated 64-detector coronary CT angiography: assessment of image quality, stenosis, and radiation dose. , 2008, Radiology.

[9]  E. Wenkel,et al.  Noninvasive visualization of coronary arteries using contrast-enhanced multidetector CT: influence of heart rate on image quality and stenosis detection. , 2002, AJR. American journal of roentgenology.

[10]  R. Detrano,et al.  Quantification of coronary artery calcium using ultrafast computed tomography. , 1990, Journal of the American College of Cardiology.

[11]  B. Lewis,et al.  Usefulness of 64-Slice Cardiac Computed Tomographic Angiography for Diagnosing Acute Coronary Syndromes and Predicting Clinical Outcome in Emergency Department Patients With Chest Pain of Uncertain Origin , 2007 .

[12]  Y. Koyama,et al.  Efficacy of multislice computed tomography for the detection of acute coronary syndrome in the emergency department. , 2005, Circulation journal : official journal of the Japanese Circulation Society.

[13]  William W O'Neill,et al.  A randomized controlled trial of multi-slice coronary computed tomography for evaluation of acute chest pain. , 2007, Journal of the American College of Cardiology.

[14]  Mark Kelemen,et al.  Chest pain evaluation in the emergency department: can MDCT provide a comprehensive evaluation? , 2005, AJR. American journal of roentgenology.

[15]  M. Reiser,et al.  Cardiac imaging by means of electrocardiographically gated multisection spiral CT: initial experience. , 2000, Radiology.

[16]  K Stierstorfer,et al.  Performance evaluation of a 64-slice CT system with z-flying focal spot. , 2004, RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin.

[17]  Udo Hoffmann,et al.  Coronary Multidetector Computed Tomography in the Assessment of Patients With Acute Chest Pain , 2006 .

[18]  Akiko Maehara,et al.  Morphologic and angiographic features of coronary plaque rupture detected by intravascular ultrasound. , 2002, Journal of the American College of Cardiology.

[19]  H. Litt,et al.  Low kVp imaging for dose reduction in dual-source cardiac CT , 2009, The International Journal of Cardiovascular Imaging.

[20]  Jonathan G Goldin,et al.  Assessment of Coronary Artery Disease by Cardiac Computed Tomography: A Scientific Statement From the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiolog , 2006, Circulation.

[21]  C. White,et al.  Chest pain in the emergency department: role of multidetector CT. , 2007, Radiology.

[22]  E. Halpern,et al.  Radiation dose in a "triple rule-out" coronary CT angiography protocol of emergency department patients using 64-MDCT: the impact of ECG-based tube current modulation on age, sex, and body mass index. , 2009, AJR. American journal of roentgenology.

[23]  A. Yeung,et al.  Impact of coronary artery remodeling on clinical presentation of coronary artery disease: an intravascular ultrasound study. , 2001, Journal of the American College of Cardiology.

[24]  B. Brundage,et al.  Detection of calcific deposits in coronary arteries by ultrafast computed tomography and correlation with angiography. , 1989, The American journal of cardiology.

[25]  L. Goldman,et al.  Evaluation of the Patient with Acute Chest Pain , 2000 .

[26]  M. Budoff,et al.  Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Indi , 2008, Journal of the American College of Cardiology.

[27]  Deepak L. Bhatt,et al.  Clinical and therapeutic profile of patients presenting with acute coronary syndromes who do not have significant coronary artery disease.The Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) Trial Investigators. , 2000, Circulation.

[28]  R. Virmani,et al.  Sudden cardiac death associated with isolated congenital coronary artery anomalies. , 1992, Journal of the American College of Cardiology.

[29]  U. Mödder,et al.  Dose Reduction in Multi-slice CT of the Heart by Use of ECG-controlled Tube Current Modulation (“ECG pulsing”): Phantom Measurements , 2002, RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin.

[30]  S. Bolling,et al.  Eccentric Mitral Regurgitation Jets Among Patients Having Sustained Inferior Wall Myocardial Infarction , 2001, Echocardiography.

[31]  W. Baxt,et al.  One-year outcomes following coronary computerized tomographic angiography for evaluation of emergency department patients with potential acute coronary syndrome. , 2009, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[32]  W. Huda,et al.  Effective doses in radiology and diagnostic nuclear medicine: a catalog. , 2008, Radiology.

[33]  R. Cury,et al.  MDCT in early triage of patients with acute chest pain. , 2006, AJR. American journal of roentgenology.

[34]  C. White,et al.  Coronary CT angiography in emergency department patients with acute chest pain: triple rule-out protocol versus dedicated coronary CT angiography , 2009, The International Journal of Cardiovascular Imaging.

[35]  L. Décourt,et al.  Myocardial bridges: morphological and functional aspects. , 1991, British heart journal.

[36]  Borut Marincek,et al.  Dual-source computed tomography in patients with acute chest pain: feasibility and image quality , 2007, European Radiology.

[37]  S. Rich,et al.  Utility of electron beam computed tomography to stratify patients presenting to the emergency room with chest pain. , 1999, The American journal of cardiology.

[38]  M. Reiser,et al.  Dual-source CT for chest pain assessment , 2007, European Radiology.

[39]  R B D'Agostino,et al.  A predictive instrument to improve coronary-care-unit admission practices in acute ischemic heart disease. A prospective multicenter clinical trial. , 1984, The New England journal of medicine.

[40]  Thomas Flohr,et al.  Multislice helical CT of the heart with retrospective ECG gating: reduction of radiation exposure by ECG-controlled tube current modulation , 2002, European Radiology.

[41]  Brian O'Neil,et al.  The diagnostic accuracy of 64-slice computed tomography coronary angiography compared with stress nuclear imaging in emergency department low-risk chest pain patients. , 2007, Annals of emergency medicine.

[42]  Werner Moshage,et al.  Noninvasive coronary angiography by retrospectively ECG-gated multislice spiral CT. , 2000 .

[43]  N. Paul,et al.  Perioperative β-Blockers : Use With Caution Perioperative β Blockers in Patients Having Non-Cardiac Surgery : A Meta-Analysis , 2010 .

[44]  M. Reiser,et al.  ECG-gated 64-MDCT angiography in the differential diagnosis of acute chest pain. , 2007, AJR. American journal of roentgenology.

[45]  C. Claussen,et al.  Estimation of the radiation exposure of a chest pain protocol with ECG-gating in dual-source computed tomography , 2008, European Radiology.

[46]  Carl J Pepine,et al.  ACC/AHA guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction--2002: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients , 2002, Circulation.

[47]  G. Raff,et al.  Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. , 2005, Journal of the American College of Cardiology.

[48]  E. Falk.  Why do plaques rupture? , 1992, Circulation.

[49]  H. Litt.  Are three diagnoses always better than one? , 2009, Academic radiology.

[50]  W. Baxt,et al.  Coronary computed tomographic angiography for rapid discharge of low-risk patients with potential acute coronary syndromes. , 2009, Annals of emergency medicine.

[51]  L. McCaig,et al.  National Hospital Ambulatory Medical Care Survey: 2000 Emergency Department Summary , 2002 .

[52]  G W Rouan,et al.  Clinical characteristics and natural history of patients with acute myocardial infarction sent home from the emergency room. , 1987, The American journal of cardiology.

[53]  R. Nishimura.  Aortic Valve Disease , 2002 .

[54]  Borut Marincek,et al.  Radiation dose estimates in dual-source computed tomography coronary angiography , 2008, European Radiology.

[55]  U. Schoepf.  Computed tomography for pulmonary embolism diagnosis: the making of a reference standard , 2005, Journal of thrombosis and haemostasis : JTH.

[56]  M. Budoff,et al.  Screening patients with chest pain in the emergency department using electron beam tomography: a follow-up study. , 2001, Journal of the American College of Cardiology.

[57]  R. Niska,et al.  National Hospital Ambulatory Medical Care Survey: 2006 emergency department summary. , 2008, National health statistics reports.

[58]  M. Shapiro.  Is the "triple rule-out" study an appropriate indication for cardiovascular CT? , 2009, Journal of cardiovascular computed tomography.

[59]  E. Antman,et al.  The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making. , 2000, JAMA.

[60]  Robert Woolard,et al.  Missed Diagnoses of Acute Cardiac Ischemia in the Emergency Department , 2000 .

[61]  J. Rumberger,et al.  Use of electron-beam computed tomography in the evaluation of chest pain patients in the emergency department. , 1999, Annals of emergency medicine.

[62]  E. Halpern,et al.  Evaluation of a "triple rule-out" coronary CT angiography protocol: use of 64-Section CT in low-to-moderate risk emergency department patients suspected of having acute coronary syndrome. , 2008, Radiology.

[63]  Renu Virmani,et al.  Healed Plaque Ruptures and Sudden Coronary Death: Evidence That Subclinical Rupture Has a Role in Plaque Progression , 2001, Circulation.