5 For this reason, chest pain units have been implemented and protocols established to expedite the diagnosis of these patients. 4 In this group of patients, the mortality or infarction rate may be 3% per month and up to 4.8% at 6 months. 3 Furthermore, ACS is misdiagnosed in up to 4% of patients with ACS, who are mistakenly discharged. 1,2 Up to 60% of patients admitted for study do not have ACS. Stratification based on clinical parameters has limited usefulness in the diagnosis and prognosis of these patients. The absence of electrocardiographic signs of ischemia or myocardial necrosis markers is common in patients with chest pain and acute coronary syndrome (ACS). La combinación de ambas técnicas podría mejorar el diagnóstico. La tomografía cardiaca es una alternativa válida al ecocardiograma de ejercicio para el diagnóstico de síndrome coronario agudo en pacientes con probabilidad baja-intermedia de enfermedad coronaria. Un valor de corte de estenosis coronaria del 70% mejoró la especificidad de la tomografía cardiaca al 88,4% manteniendo la sensibilidad del 100%. La tomografía cardiaca proporcionó una sensibilidad superior (el 100 frente al 82,3% p = 0,21) pero una especificidad inferior (el 76,9 frente al 88,4% p = 0,12) que el ecocardiograma de ejercicio, aunque sin significación estadística. El ecocardiograma de ejercicio fue normal en el 37% de los casos con tomografía cardiaca patológica. ResultadosĮl síndrome coronario agudo se confirmó en 17 casos (24,6%), cifra inferior al 42% sospechado según los hallazgos de la tomografía cardiaca (p < 0,05) y no significativamente diferente del 29% sospechado por el ecocardiograma de ejercicio (p = 0,56). Los pacientes con al menos una lesión ≥ 50% o una puntuación de calcio de Agatston ≥ 400 en la tomografía cardiaca, ecocardiograma de ejercicio positivo o con resultados no concluyentes ingresaron para completar estudio. Se incluyó prospectivamente a 69 sujetos con dolor torácico agudo y troponinas y electrocardiograma normales a los que se realizó una tomografía cardiaca y un ecocardiograma de ejercicio. El presente estudio compara la utilidad diagnóstica de la tomografía cardiaca y el ecocardiograma de ejercicio en pacientes con probabilidad baja-intermedia de enfermedad coronaria. Un 4% de los pacientes con dolor torácico agudo y troponinas y electrocardiograma normales presentan eventos cardiacos adversos como consecuencia del síndrome coronario agudo no diagnosticado. A combination of both techniques could improve the diagnosis of acute coronary syndrome. ConclusionsĬoronary tomography angiography offers a valid alternative to exercise echocardiography for the diagnosis of acute coronary syndrome among patients with low-to-intermediate probability of coronary artery disease. Increasing the stenosis cutoff point to 70% increased the specificity of coronary tomography angiography to 88.4%, while maintaining high sensitivity. 12) than exercise echocardiography for the diagnosis of acute coronary syndrome, although without reaching statistical significance. The latter technique provided a higher sensitivity (100% vs 82.3% P =. Exercise echocardiography was normal in up to 37% of patients with pathological findings on coronary tomography angiography. 05) and not significantly different than the suspected 29% based on the results of exercise echocardiography ( P =. This was lower than the suspected 42% based on coronary tomography angiography ( P <. ResultsĪn acute coronary syndrome was confirmed in 17 patients (24.6%). Patients with coronary stenosis ≥ 50% or Agatston calcium score ≥ 400 on coronary tomography angiography or positive exercise echocardiography, or with inconclusive results, were admitted to rule out acute coronary syndrome. We prospectively included 69 patients with acute chest pain, normal electrocardiogram, and negative troponins who underwent coronary tomography angiography and exercise echocardiography. Our aim was to compare the diagnostic performance of multidetector computed tomography and exercise echocardiography in patients with a low-to-intermediate probability of coronary artery disease. Up to 4% of patients with acute chest pain, normal electrocardiogram, and negative troponins present major adverse cardiac events as a result of undiagnosed acute coronary syndrome.
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