29. Triple rule out versus standard coronary computed tomography angiography in evaluation of acute chest pain syndrome.

Abstract

Acute chest pain (ACP) in emergency department represents a health care challenge. Triple-rule-out (TRO) Computed Tomography Angiography (CTA) can provide an evaluation of the coronary arteries, aorta,Pulmonary arteries, and chest structures in one scan. The aim of our work was to evaluate the diagnostic yield of TRO versus cardiac CTA in patients with ACP, In addition to compare the image quality, contrast material and radiation doses of TRO with standard CTA.We hypothesized that TRO CTA has a comparable diagnostic yield to standard coronary CTA, in addition to its ability to add extra diagnostic information. Prospective analysis of 134 TRO CTA data, to assess the presence of coronary artery disease(CAD), Aortic dissection, pulmonary embolism and other chest pathology. Then retrospectively to compare the results with 132 standard CTA. Normal coronaries or non-significant CAD was seen in 97 (72.9%) patients, 19 (14.2%) had moderate or significant CAD, two (1.5%) had aortic dissection, three (2.2%) had a pulmonary embolism, 61% had other findings. The image quality score and noise were comparable between the standard and TRO CTA (2.8 ± 0.6 vs 2.96 ± 0.6, P = 0.28) and (30.5 ± 10.6 vs 28.4 ± 1, P = 0.1) respectively. The effective radiation dose was significantly lower in the standard compared to the TRO CTA using prospective (4.4 ± 1.7 vs. 5.1 ± 0.5 mSv = 0.008) and (11.9 vs. 18.3 ± 5 msv, P = 0.0001) for retrospective gating protocols. The contrast dose was lower with standard protocol (83 ± 5 vs 102 ± 9 ml. p = 0.001). TRO CTA is a valid tool for diagnosis of CAD and can provide accurate detection of non-coronary pathology, but it was associated with higher radiation and contrast doses compared to the standard CTA.