Cardiac MDCT for Early Triage of Patients with ACS

心脏 MDCT 用于 ACS 患者早期分诊

• 批准号: 7034150
• 负责人: UDO HOFFMANN
• 金额: $ 46.2万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-02-15 至 2008-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7034150
• 关键词: angina pectoris; angiography; artery stenosis; atherosclerotic plaque; bioimaging /biomedical imaging; biomarker; cardiovascular disorder risk; clinical research; computed axial tomography; computer assisted medical decision making; contrast media; coronary occlusion /thrombosis; cost effectiveness; diagnosis design /evaluation; diagnosis quality /standard; electrocardiography; emergency health services; health services research tag; heart disorder diagnosis; heart imaging /visualization /scanning; hospital utilization; human subject; myocardial infarction; myocardial ischemia /hypoxia; pain

DESCRIPTION (provided by applicant): The goal of this research is to determine noninvasively whether detection of coronary stenosis and plaque by multidetector computed tomography (MDCT) in patients with acute chest pain suspected of acute coronary syndrome (ACS) enhances triage, reduces cost and is cost effective. Among the 5.6 million patients with ACP presenting annually in emergency departments (ED) in the United States, a subgroup of two million patients is hospitalized despite normal initial cardiac biomarker tests and electrocardiogram (ECG). This subgroup is at low (20%) risk for ACS during the index hospitalization. Most (80-94%) patients with a diagnosis of ACS have a significant epicardial coronary artery stenosis ( >50% luminal narrowing). However, in -10% of patients non-stenotic coronary plaque triggers events, i.e. vasospasms, leading to myocardial ischemia. Since the absence of plaque excludes a coronary cause of chest pain, these patients could in theory be discharged earlier reducing unnecessary hospital admissions. Recent publications demonstrate high sensitivity and specificity of MDCT for the detection of significant coronary stenosis compared with coronary angiography and the detection of coronary plaque as validated with intravascular ultrasound. Using 64- slice MDCT we propose to study 400 patients with ACP, negative initial cardiac biomarkers and non-diagnostic ECG. We will analyze MDCT images for the presence of significant coronary artery stenosis and plaque and correlate the data with the clinical diagnosis of ACS (AHA guidelines) during the index hospitalization to determine the sensitivity and specificity. MDCT data, risk factors, and the results of standard diagnostic tests available at the time of MDCT will be used to generate a multivariate prediction function and derive a clinical decision rule. Based on this decision rule we will compare the diagnostic accuracies and cost effectiveness of competing strategies. We hypothesize that an MDCT- based diagnostic strategy will reduce the time to diagnosis of ACS, number of hospitalizations, and absolute cost of management of patients with acute chest pain compared to standard clinical care and is cost effective.

描述（由申请人提供）：本研究的目的是确定通过多排计算机断层扫描（MDCT）对疑似急性冠脉综合征（ACS）的急性胸痛患者进行无创检测冠状动脉狭窄和斑块是否可以增强分诊、降低成本和具有成本效益。在美国，每年有 560 万名 ACP 患者到急诊科 (ED) 就诊，其中有 200 万名患者尽管初始心脏生物标志物测试和心电图 (ECG) 正常，但仍然住院。该亚组在指数住院期间发生 ACS 的风险较低（20%）。大多数（80-94%）诊断为 ACS 的患者有显着的心外膜冠状动脉狭窄（管腔狭窄 >50%）。然而，在-10%的患者中，非狭窄冠状动脉斑块会引发事件，即血管痉挛，导致心肌缺血。由于没有斑块排除了胸痛的冠状原因，理论上这些患者可以提前出院，减少不必要的住院。最近的出版物表明，与冠状动脉造影相比，MDCT 在检测显着冠状动脉狭窄方面具有较高的敏感性和特异性，并且通过血管内超声验证冠状动脉斑块的检测。我们建议使用 64 层 MDCT 研究 400 名 ACP、初始心脏生物标志物阴性和非诊断性心电图患者。我们将分析 MDCT 图像是否存在明显的冠状动脉狭窄和斑块，并将数据与首次住院期间的 ACS 临床诊断（AHA 指南）相关联，以确定敏感性和特异性。 MDCT 数据、风险因素以及 MDCT 时可用的标准诊断测试结果将用于生成多变量预测函数并得出临床决策规则。基于这个决策规则，我们将比较竞争策略的诊断准确性和成本效益。我们假设，与标准临床护理相比，基于 MDCT 的诊断策略将减少 ACS 的诊断时间、住院次数以及急性胸痛患者的绝对治疗成本，并且具有成本效益。