Frequency of Non-Coronary Findings Detected on Computed Tomography Coronary Angiography that Lead to a Non-Coronary Diagnosis of Chest Pain

Abstract

Background: CT coronary angiography (CTCA) can detect non-coronary abnormalities in patients undergoing imaging to exclude coronary artery disease. We sought to determine the frequency of non-coronary findings detected on CTCA that lead to a non-coronary diagnosis of chest pain in a population discharged from the Emergency Department (ED) with non-obstructive coronary disease. Methods: We prospectively evaluated 415 consecutive patients (mean age 58 ± 13 years, 56% male) who were discharged from ED after presenting with ischaemic-sounding chest pain at low-to-intermediate risk for an acute coronary syndrome having undergone investigation with 320-row CTCA that showed either no or mild coronary artery disease. CTCA studies were reported by consensus between a cardiologist and radiologist. Results: Non-coronary findings that led to a diagnosis of a non-coronary cause of chest pain were detected in 23 patients (5%). This comprised 16 patients with pulmonary inflammatory changes suggestive of pneumonia, four with small pericardial effusions suggesting pericarditis and three with thoracic vertebral fractures suggesting musculoskeletal chest pain. No patient had an aortic dissection or pulmonary embolism, although ‘triple-rule out’ imaging was not specifically performed. Conclusions: Non-coronary findings detected on CTCA that lead to a non-coronary diagnosis of chest pain occur in a small proportion of patients discharged from the Emergency Department (ED) with non-obstructive coronary disease. The low frequency of non-coronary CTCA diagnoses is likely to be a reflection of selective investigation associated with the use of an ED CTA-guided chest pain diagnostic algorithm.