A computed tomography-based coronary lesion score to predict acute coronary syndrome among patients with acute chest pain and significant coronary stenosis on coronary computed tomographic angiogram
The American Journal of Cardiology, 07/06/2012
Ferencik M et al. – In patients presenting with acute chest pain and stenosis on coronary computed tomographic angiogram (CTA), a CT–based score incorporating morphologic characteristics of coronary lesions had a good discriminatory value for detection of acute coronary syndrome (ACS) during index hospitalization.Methods
- Patients who presented to an emergency department with chest pain but no objective signs of myocardial ischemia (nondiagnostic electrocardiogram and negative initial biomarkers) underwent CT angiography.
- CTA was analyzed for degree and length of stenosis, plaque area and volume, remodeling index, CT attenuation of plaque, and spotty calcium in all patients with significant stenosis (>50% in diameter) on CTA.
- ACS during index hospitalization was determined by a panel of 2 physicians blinded to results of CT angiography.
- For lesion characteristics associated with ACS, authors determined cutpoints optimized for diagnostic accuracy and created lesion scores.
- For each score, authros determined the odds ratio (OR) and discriminatory capacity for the prediction of ACS.
- Of the overall population of 368 patients, 34 had significant stenosis and 21 of those had ACS.
- Scores A (remodeling index plus spotty calcium: OR 3.5, 95% confidence interval [CI] 1.2 to 10.1, area under curve [AUC] 0.734), B (remodeling index plus spotty calcium plus stenosis length: OR 4.6, 95% CI 1.6 to 13.7, AUC 0.824), and C (remodeling index plus spotty calcium plus stenosis length plus plaque volume <90 HU: OR 3.4, 95% CI 1.5 to 7.9, AUC 0.833) were significantly associated with ACS.