LAUSR

Introduction: Chest pain syndromes are one of the most common causes of hospital admission. The correct diagnosis as cardiac [acute coronary syndromes (ACS)] with associated morbidity and mortality, or non-cardiac has important medical and legal consequences. Appropriate and timely diagnosis of these conditions is essential, yet limited literature exists comparing two common diagnostic tools, CT coronary angiography (CTCA) and nuclear stress testing (NST) in the acute inpatient setting. Methods: We conducted a retrospective analysis to determine rates of ischemia and intervention needed in patients without ischemic cardiac history, who were evaluated for ACS with NST or CTCA and who subsequently underwent invasive coronary angiography (IA) with iFR and angioplasty as appropriate. Results: We identified 121 CTCA cases and 45 NST cases. There were no significant difference in age, rates of hypertension, diabetes mellitus, renal disease, aspirin or statin use. However, there were more male patients in the CTCA group and higher mean GRACE scores and creatinine on admission in the NST group. Patients who underwent CTCA were found to have higher rates of significant coronary artery disease defined as iFR < 0.9 or ≥70% stenosis on IA (63% vs 44%), and shorter mean length of stay (4.5 vs 6.5 days). Rates of artifact were higher in the NST group (64% vs 24%) and CTCA demonstrated higher specificity (90% vs 28%) and greater positive predictive value (92% vs. 41%) than NST. (Table 1) Conclusions: Our study found that CTCA compared to NST in admitted patients being evaluated for chest pain syndromes was associated with lower rates of reported artifact, shorter length of stay, higher rates of IA confirmed significant coronary disease, and higher specificity and positive predictive value for needed intervention when evaluated with IA. While limited by its single center analysis, our study demonstrates the potential value of CTCA in a real-world population which merits further study.