High-resolution computed tomography in patients with atypical 'cardiac' chest pain: a study investigating patients at 10-year cardiovascular risks defined by the Framingham and PROCAM scores

• Published in: Journal of geriatric cardiology : JGC Vol. 3; no. 1; pp. 17 - 21
• Main Author: Choon Kiat ANG Alan Yean Yip FONG Sze Piaw CHIN Tiong Kiam ONG Seyfarth M Tobias Wei Ling CHAN Chee Khoon LIEW Rapaee ANNUAR Houng Bang LIEW Kui Hian SIM
• Format: Journal Article
• Language: English
• Published: Deptartment of Cardiology, Sarawak General Hospital, Sarawak, Malaysia%Siemens Medical Solutions, Germany%University Malaysia Sarawak, Malaysia 01.03.2006
• Subjects: artery; atypical; cardiac; chest; computed; coronary; disease; multi-detector; pain; risk; stratification; tomography; coronary artery disease; risk stratification; multi-detector computed tomography; atypical 'cardiac' chest pain
• ISSN: 1671-5411

Background and objective Atypical 'cardiac' chest pain (ACCP) is not usually caused by myocardial ischaemia. Current noninvasive investigations for these symptoms are not yet as accurate as invasive coronary angiography. The latest 64-row multi-detector computed tomography (MDCT) technology is non-invasive, has high specificity and negative predictive values for the detection of significant coronary disease. Our aim was to investigate if this modality can provide more information in the assessment of outpatients with ACCP in addition to established cardiovascular risk scores. Methods Seventy consecutive patients presenting to the outpatient clinic with ACCP underwent 64-row MDCT scan of the coronary arteries. They were categorized into low, medium or high risk groups based upon the Framingham and PROCAM scores. We defined a clinically abnormal MDCT scan as coronary stenosis =50% or calcium score ＞400 Agatston. Results Fifty-three (75.7%) patients did not have clinically abnormal scans. Framingham score classified 43 patients as low-risk while PROCAM classified 59 patients as low-risk. MDCT scans were abnormal for 18.6% and 22.0% of the respective low-risk group of patients. For patients with medium-to-high risk, 33.3% and 36.4% of Framingham and PROCAM patient groups respectively had abnormal MDCT scans. Conclusion MDCT adds valuable information in the assessment of patients with ACCP by identifying a significant proportion of patients categorized as low-risk to have underlying significant coronary stenosis and coronary calcification by established cardiovascular risk scores.