NEW YORK (Reuters Health), Nov 30 - Women younger than 65 years and men younger than 55 with acute chest pain benefit most from cardiac CT angiography (CTA) for suspected acute coronary syndrome (ACS), results of a study indicate.
"The key finding of the study is that not all patients benefit similarly from the test, which is important as we use contrast agent and some radiation and only those who benefit should be exposed to these potential side effects," Dr. Fabian Bamberg, from the Institute of Clinical Diagnostic Radiology Ludwig-Maximilians University, Munich, Germany told Reuters Health.
There is growing evidence that cardiac CTA may enhance the workup of patients with acute chest pain, Dr. Bamberg and colleagues note in the November 1 issue of the American Journal of Cardiology. Yet it remains unclear in which subpopulation the test yields the highest diagnostic benefit.
To investigate, they studied 368 patients with the chief complaint of acute chest pain and inconclusive workup (nondiagnostic electrocardiographic findings, negative cardiac biomarkers) who underwent cardiac CTA to rule out myocardial infarction (MI). The patients had a mean age of 52.7 years, 61% were men, and 8% had ACS.
The presence of significant coronary stenosis on CTA and the occurrence of ACS increased with age for both men and women (p < 0.001), the study team reports.
"Interestingly," Dr. Bamberg told Reuters Health, the results showed that cardiac CTA in patients presenting with acute chest pain "is most useful in women younger than 65 years of age and men younger than 55 years of age, which may have huge consequences for the management of these patients."
In women younger than 65, cardiac CTA had a sensitivity of 100% and a specificity of 87%. In men, sensitivity was 100% for those younger than age 45 and 80% for those 45 to 54 years old. Specificity in men younger than 55 was greater than 88.2%.
In contrast, "the diagnostic accuracy was very moderate in older women and men indicating very limited value in these subjects," Dr. Bamberg said. "Thus, clinicians could use our simple criteria (age and gender) to determine in whom CTA is useful in the emergency department."
By Megan Brooks
Am J Cardiol 2009;104:1165-1170.
Last Updated: 2009-11-27 10:00:13 -0400 (Reuters Health)
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