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Estudio piloto de la utilidad de la tomografía computarizada cardiaca para descartar síndrome coronario agudo en urgencias

2010; Spanish Society of Emergency Medicine; Volume: 22; Issue: 2 Linguagem: Espanhol

2386-5857

Òscar Miró, Jose T. Ortiz‐Pérez, Rafael León, Beatriz López, Rosario J. Perea, Teresa M. de Caralt, Marta Sitges, Carles Paré, Xavier Bosch, Ernest Bragulat, Miquel Sánchez,

Cardiac electrophysiology and arrhythmias

espanolOBJETIVO: Analizar, en pacientes con dolor toracico de bajo riesgo, las aportaciones de la coronariografia por tomografia computarizada multidetector (TCMD) en el diagnostico de sindrome coronario agudo (SCA). METODO: Subestudio piloto descriptivo y retrospectivo de un estudio prospectivo que comparaba la rentabilidad diagnostica de la ecografia de estres con la angiografia por TCMD. Se realizo en una unidad de dolor toracico (UDT) que atiende a pacientes con dolor toracico no traumatico. Se incluyeron, en 2008, pacientes sin coronariopatia conocida y con al menos 2 factores de riesgo coronario y dolor toracico con estudio habitual (historia clinica, electrocardiogramas, troponinas seriadas y ergometria) negativo para SCA. Se registraron datos clinicos, epidemiologicos y se les realizo una coronariografia por TCMD y, si era patologica, un cateterismo. RESULTADOS: De los 502 pacientes con posible SCA atendidos durante la disponibilidad de la prueba, 54 (10,7%) cumplian criterios para la TCMD. La TCMD mostro coronarias normales en 35 (64,8%); en 3 (5,5%), no interpretables por artefactos; y en 16 (29,6%) la TCMD fue patologica. En estos ultimos, se practicaron 15 cateterismos, de los que 10 fueron patologicos. Asi, la TCMD permitio el diagnostico de SCA en un 2,0% adicional de los pacientes incluidos inicialmente en el grupo de posible SCA y el 18,5% de los 54 pacientes finalmente incluidos. CONCLUSIONES: La TCMD cardiaca aumento el rendimiento diagnostico de un protocolo estandar (historia clinica, electrocardiogramas y troponinas seriadas y ergometria) en los pacientes con dolor toracico. EnglishOBJECTIVE: To analyze the diagnostic contribution of coronary multidetector computed tomography (CMCT) in low-risk chest pain patients. METHODS: Retrospective, descriptive substudy as part of a prospective study of the diagnostic yield of stress echocardiography in comparison with CMCT angiography. The setting was a non-traumatic chest pain unit. Patients with chest pain but without diagnosed coronary artery disease and fewer than 2 coronary risk factors in 2008 were included if the information usually gathered to diagnose acute coronary syndrome (ACS) (ie, medical history, electrocardiogram, troponin series, and ergometry) was negative. Clinical and patient data were recorded and CMCT was performed; if abnormalities were detected, heart catheterism was undertaken. RESULTS: Of the 502 patients suspected of having ACS while CMCT was available to the department, 54 (10.7%) met the criteria for performing the procedure. CMCT demonstrated normal coronary arteries in 35 (64.8%). In 3 (5.5%) the findings could not be interpreted due to artifacts and in 16 (29.6%), abnormalities were detected. Catheterization was performed in 15 of the 16 patients; the test was positive in 10. CMCT led to a diagnosis of ACS in an additional 2% of the group of patients in whom the diagnosis was initially suspected and in 18.5% of the 54 patients included in the CMCT study. CONCLUSIONS: CMCT contributed additional diagnoses of ACS when the procedure was used to complement the standard protocol (history, ECG, troponin series, and ergometry) in patients with chest pain.