Evidence map›Paper›PMID 25752898›Full record

Observational studyCirculation. Cardiovascular imaging2015

Early resting myocardial computed tomography perfusion for the detection of acute coronary syndrome in patients with coronary artery disease.

Amit Pursnani, Ashley M Lee, Thomas Mayrhofer, Waleed Ahmed, Shanmugam Uthamalingam, Maros Ferencik, Stefan B Puchner, Fabian Bamberg, Christopher L Schlett, James Udelson and 2 more

Registry-linked trialAbstract readComparative StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Circulation. Cardiovascular imaging, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00990262 (Accuracy of Contrast Enhanced Multidetector Computed Tomography to Identify Cardiac Cause of Symptoms in Patients With Intermediate Likelihood of Acute Coronary Syndrome), which is not on this map. Cited by 15 papers.

0numbers the graph read from it
0cells of the map it votes in
15citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00990262 completednot on this map

Accuracy of Contrast Enhanced Multidetector Computed Tomography to Identify Cardiac Cause of Symptoms in Patients With Intermediate Likelihood of Acute Coronary Syndrome (ACS) - A Comparison to Standard Care

TypeobservationalSponsorMassachusetts General HospitalRan2005 to 2009Enrolled368ConditionsAcute Coronary Syndrome, Myocardial Infarction, Unstable Angina PectorisArmsCardiac Computed Tomography
3 · Its place in the literature

Who cites it

15 citing papers in PubMed.

  1. Article
  2. Role of cardiac imaging in acute chest pain.The British journal of radiology · 2023
    Review
  3. Review
  4. Article
  5. Article
  6. Article
  7. Article
  8. Article
  9. Observational
  10. In silico evaluation of the acute occlusion effect of coronary artery on cardiac electrophysiology and the body surface potential map.The Korean journal of physiology & pharmacology : official journal of the Korean Physiological Society and the Korean Society of Pharmacology · 2019
    Article
  11. Article
  12. Dynamic Monitoring of Erythrocyte Distribution Width (RDW) and Platelet Distribution Width (PDW) in Treatment of Acute Myocardial Infarction.Medical science monitor : international medical journal of experimental and clinical research · 2017
    Article
  13. Review
  14. Update on Computed Tomography Myocardial Perfusion Imaging.Current cardiovascular imaging reports · 2016
    Article
  15. Chest pain: coronary CT in the ER.The British journal of radiology · 2016
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Amit PursnaniFrom the Cardiovascular Division, NorthShore University HealthSystem, Evanston, IL (A.P.); Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (A.P., A.M.L., T.M., W.A., S.U., M.F., S.B.P., U.H., B.B.G.); Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany (F.B.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.L.S.); and Division of Cardiology and Cardiovascular Center, Tufts Medical Center, Boston, MA (J.U.). apursnani@northshore.org.
Ashley M LeeFrom the Cardiovascular Division, NorthShore University HealthSystem, Evanston, IL (A.P.); Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (A.P., A.M.L., T.M., W.A., S.U., M.F., S.B.P., U.H., B.B.G.); Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany (F.B.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.L.S.); and Division of Cardiology and Cardiovascular Center, Tufts Medical Center, Boston, MA (J.U.).
Thomas MayrhoferFrom the Cardiovascular Division, NorthShore University HealthSystem, Evanston, IL (A.P.); Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (A.P., A.M.L., T.M., W.A., S.U., M.F., S.B.P., U.H., B.B.G.); Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany (F.B.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.L.S.); and Division of Cardiology and Cardiovascular Center, Tufts Medical Center, Boston, MA (J.U.).
Waleed AhmedFrom the Cardiovascular Division, NorthShore University HealthSystem, Evanston, IL (A.P.); Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (A.P., A.M.L., T.M., W.A., S.U., M.F., S.B.P., U.H., B.B.G.); Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany (F.B.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.L.S.); and Division of Cardiology and Cardiovascular Center, Tufts Medical Center, Boston, MA (J.U.).
Shanmugam UthamalingamFrom the Cardiovascular Division, NorthShore University HealthSystem, Evanston, IL (A.P.); Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (A.P., A.M.L., T.M., W.A., S.U., M.F., S.B.P., U.H., B.B.G.); Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany (F.B.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.L.S.); and Division of Cardiology and Cardiovascular Center, Tufts Medical Center, Boston, MA (J.U.).
Maros FerencikFrom the Cardiovascular Division, NorthShore University HealthSystem, Evanston, IL (A.P.); Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (A.P., A.M.L., T.M., W.A., S.U., M.F., S.B.P., U.H., B.B.G.); Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany (F.B.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.L.S.); and Division of Cardiology and Cardiovascular Center, Tufts Medical Center, Boston, MA (J.U.).
Stefan B PuchnerFrom the Cardiovascular Division, NorthShore University HealthSystem, Evanston, IL (A.P.); Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (A.P., A.M.L., T.M., W.A., S.U., M.F., S.B.P., U.H., B.B.G.); Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany (F.B.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.L.S.); and Division of Cardiology and Cardiovascular Center, Tufts Medical Center, Boston, MA (J.U.).
Fabian BambergFrom the Cardiovascular Division, NorthShore University HealthSystem, Evanston, IL (A.P.); Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (A.P., A.M.L., T.M., W.A., S.U., M.F., S.B.P., U.H., B.B.G.); Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany (F.B.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.L.S.); and Division of Cardiology and Cardiovascular Center, Tufts Medical Center, Boston, MA (J.U.).
Christopher L SchlettFrom the Cardiovascular Division, NorthShore University HealthSystem, Evanston, IL (A.P.); Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (A.P., A.M.L., T.M., W.A., S.U., M.F., S.B.P., U.H., B.B.G.); Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany (F.B.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.L.S.); and Division of Cardiology and Cardiovascular Center, Tufts Medical Center, Boston, MA (J.U.).
James UdelsonFrom the Cardiovascular Division, NorthShore University HealthSystem, Evanston, IL (A.P.); Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (A.P., A.M.L., T.M., W.A., S.U., M.F., S.B.P., U.H., B.B.G.); Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany (F.B.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.L.S.); and Division of Cardiology and Cardiovascular Center, Tufts Medical Center, Boston, MA (J.U.).
Udo HoffmannFrom the Cardiovascular Division, NorthShore University HealthSystem, Evanston, IL (A.P.); Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (A.P., A.M.L., T.M., W.A., S.U., M.F., S.B.P., U.H., B.B.G.); Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany (F.B.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.L.S.); and Division of Cardiology and Cardiovascular Center, Tufts Medical Center, Boston, MA (J.U.).
Brian B GhoshhajraFrom the Cardiovascular Division, NorthShore University HealthSystem, Evanston, IL (A.P.); Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (A.P., A.M.L., T.M., W.A., S.U., M.F., S.B.P., U.H., B.B.G.); Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany (F.B.); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.L.S.); and Division of Cardiology and Cardiovascular Center, Tufts Medical Center, Boston, MA (J.U.).

Funding

Cardiac MR and CT ResearchT32HL076136 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI NEILAN, TOMAS G · 2004 to 2019
$4.9M
Cardiac MDCT for Early Triage of Patients with ACSR01HL080053 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI HOFFMANN, UDO · 2006 to 2008
$1.5M
Cardiovascular Imaging in Ischemic Heart DiseaseK24HL113128 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI HOFFMANN, UDO · 2012 to 2020
$1.1M
NHLBI NIH HHS 5K24HL113128NHLBI NIH HHS K24 HL113128NHLBI NIH HHS R01 HL080053NHLBI NIH HHS T32 HL076136
6 · The paper itself

Abstract

backgroundAcute rest single-photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI) has high predictive value for acute coronary syndrome (ACS) in emergency department patients. Prior studies have shown excellent agreement between rest/stress computed tomography perfusion (CTP) and SPECT-MPI, but the value of resting CTP (rCTP) in acute chest pain triage remains unclear. We sought to determine the diagnostic accuracy of early rCTP, incremental value beyond obstructive coronary artery disease (CAD; ≥50% stenosis), and compared early rCTP to late stress SPECT-MPI in patients with CAD presenting with suspicion of ACS to the emergency department. METHODS AND

resultsIn this prespecified subanalysis of 183 patients (58.1±10.2 years; 33% women), we included patients with any CAD by coronary computed tomography angiography (CCTA) from Rule Out Myocardial Infarction Using Computer-Assisted Tomography I. rCTP was assessed semiquantitatively, blinded to CAD interpretation. Overall, 31 had ACS and 48 had abnormal rCTP. Sensitivity and specificity of rCTP for ACS were 48% (95% confidence interval [CI], 30%-67%) and 78% (95% CI, 71%-85%), respectively. rCTP predicted ACS (adjusted odds ratio, 3.40 [95% CI, 1.37-8.42]; P=0.008) independently of obstructive CAD, and sensitivity for ACS increased from 77% (95% CI, 59%-90%) for obstructive CAD to 90% (95% CI, 74%-98%) with addition of rCTP (P=0.05). In a subgroup undergoing late rest/stress SPECT-MPI (n=81), CCTA/rCTP had noninferior discriminatory value to CCTA/SPECT-MPI (area under the curve, 0.88 versus 0.90; P=0.64) using a noninferiority margin of 10%.

conclusionsEarly rCTP provides incremental value beyond obstructive CAD to detect ACS. CCTA/rCTP is noninferior to CCTA/SPECT-MPI to discriminate ACS and presents an attractive alternative to triage patients presenting with acute chest pain. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00990262.

Indexed as

Multidetector Computed TomographyAcute Coronary SyndromeAgedArea Under CurveCoronary AngiographyCoronary Artery DiseaseCoronary CirculationCoronary StenosisCoronary VesselsEmergency Service, HospitalFemaleHumansLogistic ModelsMaleMiddle AgedMultivariate Analysisemergency service, hospitalperfusionscannerstomography, computed

Identifiers

PMID25752898
PMCPMC5996992

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.