الفهرس | Only 14 pages are availabe for public view |
Abstract Evaluation of chest pain in the Emergency Department (ED) is a public health issue of great consequence. The differential diagnosis of chest pain is a complex problem for the ED physician. The goal of diagnostic imaging is to triage patients in the emergency department and allow for safe and rapid discharge directly from the emergency department after life-threatening conditions have been excluded. Recent technologic advances in MDCT have led to notable improvements in both cardiac and thoracic applications of CT. ECG-Gated MDCT acute chest pain protocol allow a rapid and safe discharge in the majority of patients presenting with acute chest pain and an intermediate risk for ACS while at the same time identifies those with significant coronary artery stenosis. In contrast to CCTA, ECG-Gated MDCT acute chest pain protocol that we used in our study simultaneously evaluates the pulmonary arteries, entire thoracic aorta, and additional portions of the adjacent lung zones. Our study was conducted on 44 patients with nonspecific acute chest pain. All patients were referred from the Emergency Department (ED) to the radiology department at Ain Shams University Hospitals and private centers in East of Cairo.Our aim was to assess the diagnostic yield and accuracy of ECG-gated MDCT in the assessment of low and intermediate risk acute coronary syndrome (ACS) patients presented with acute chest pain in the ED. Appropriate patient selection is important for the effective application of ECG-gated MDCT acute chest pain protocol. A high negative predictive value, which is useful in the acute care setting, relies on a patient population with a low to intermediate risk of ACS, allowing the safe and rapid discharge of patients directly from the emergency department after the results of CT evaluation are found to be negative. Our study estimated the diagnostic accuracy by comparing our final report with the final diagnosis obtained after 30 days follow up and the result came up to be sensitivity of 91.4%, specificity of 100%, positive predictive value of 100% and negative predictive value of 90% with overall diagnostic accuracy of 93.18%. These diagnostic values are not significantly different from those using other techniques for the functional exploration of myocardial ischemia. clinical data on efficacy and safety did not discriminate between the different values of coronary CT angiography, cardiac scintigraphy, and echocardiography or stress MRI, with ECG-Gated MDCT acute chest pain protocol having the advantage over CCTA in evaluating other extracardiac structures and assisting the left ventricular function. |