Coronary Computed Tomography Angiography for Early Triage of Patients With Acute Chest Pain. The ROMICAT (Rule Out Myocardial Infarction using Computer Assisted Tomography) Trial

Udo Hoffmann, Fabian Bamberg, Claudia U. Chae, John H. Nichols, Ian S. Rogers, Sujith K. Seneviratne, Quynh A. Truong, Ricardo C. Cury, Suhny Abbara, Michael D. Shapiro, Jamaluddin Moloo, Javed Butler, Maros Ferencik, Hang Lee, Ik Kyung Jang, Blair A. Parry, David F. Brown, James E. Udelson, Stephan Achenbach, Thomas J. BradyJohn T. Nagurney

Research output: Contribution to journalArticle

420 Scopus citations

Abstract

Objectives: This study was designed to determine the usefulness of coronary computed tomography angiography (CTA) in patients with acute chest pain. Background: Triage of chest pain patients in the emergency department remains challenging. Methods: We used an observational cohort study in chest pain patients with normal initial troponin and nonischemic electrocardiogram. A 64-slice coronary CTA was performed before admission to detect coronary plaque and stenosis (>50% luminal narrowing). Results were not disclosed. End points were acute coronary syndrome (ACS) during index hospitalization and major adverse cardiac events during 6-month follow-up. Results: Among 368 patients (mean age 53 ± 12 years, 61% men), 31 had ACS (8%). By coronary CTA, 50% of these patients were free of coronary artery disease (CAD), 31% had nonobstructive disease, and 19% had inconclusive or positive computed tomography for significant stenosis. Sensitivity and negative predictive value for ACS were 100% (n = 183 of 368; 95% confidence interval [CI]: 98% to 100%) and 100% (95% CI: 89% to 100%), respectively, with the absence of CAD and 77% (95% CI: 59% to 90%) and 98% (n = 300 of 368, 95% CI: 95% to 99%), respectively, with significant stenosis by coronary CTA. Specificity of presence of plaque and stenosis for ACS were 54% (95% CI: 49% to 60%) and 87% (95% CI: 83% to 90%), respectively. Only 1 ACS occurred in the absence of calcified plaque. Both the extent of coronary plaque and presence of stenosis predicted ACS independently and incrementally to Thrombolysis In Myocardial Infarction risk score (area under curve: 0.88, 0.82, vs. 0.63, respectively; all p < 0.0001). Conclusions: Fifty percent of patients with acute chest pain and low to intermediate likelihood of ACS were free of CAD by computed tomography and had no ACS. Given the large number of such patients, early coronary CTA may significantly improve patient management in the emergency department.

Original languageEnglish (US)
Pages (from-to)1642-1650
Number of pages9
JournalJournal of the American College of Cardiology
Volume53
Issue number18
DOIs
StatePublished - May 5 2009

Keywords

  • acute chest pain
  • cardiac CT
  • emergency department

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Hoffmann, U., Bamberg, F., Chae, C. U., Nichols, J. H., Rogers, I. S., Seneviratne, S. K., Truong, Q. A., Cury, R. C., Abbara, S., Shapiro, M. D., Moloo, J., Butler, J., Ferencik, M., Lee, H., Jang, I. K., Parry, B. A., Brown, D. F., Udelson, J. E., Achenbach, S., ... Nagurney, J. T. (2009). Coronary Computed Tomography Angiography for Early Triage of Patients With Acute Chest Pain. The ROMICAT (Rule Out Myocardial Infarction using Computer Assisted Tomography) Trial. Journal of the American College of Cardiology, 53(18), 1642-1650. https://doi.org/10.1016/j.jacc.2009.01.052