SHA24/061008

Comparison between CTA and acute rest myocardial perfusion imaging

Availability

++++

++++

Imaging time

Seconds

Minutes

Total patient preparation

10–20 min

5 min

Processing /interpretation

10–30 min

10–20 min

Radiation

1–20 mSv

4 mSv

Ancillary data obtained

Lungs, aorta

LVEF

Incidental findings

Common

AHA/ACC recommendations Class

IIA

IA

AHA/ACC appropriateness criteria

7

7

Rare

1

Suggested Diagnostic Strategy for acute chest pain ER • Acute coronary syndrome – Cath lab, in less than 90 min

• Unstable angina – Cath lab within 24 hours

• Suspected ACS ( TIMI score more than 2) – Nuclear Imaging , R/O ischemia

• Suspected CAD (TIMI Score less than 2) – Coronary CTA

• Non-Cardiac chest pain – CXR,VQ scan, other test to established Diagnosis

Cardiac CT in the emergency department: Convincing evidence, but cautious Implementation. J Nucl Cardiol 2011;18:331–41.

2

Cardiac CT in the emergency department: Convincing evidence, but cautious Implementation. J Nucl Cardiol 2011;18:331–41.

3

Coronary CTA Degree of coronary stenosis 0

40%

MILD Discharge from ED and OP consult with Cardiologist

70%

Moderate Stress MPI Or Cath withFFR

70%- 100%

Severe Cath Lab

4

False negative SPECT 5

Nondiagnostic SPECT

6

7

8

Summary • Anatomical and functional imaging are very accurate and should guide the patient management accurately • In many situation both functional and anatomical imaging are complementary • Every patient should be evaluated for pretest probability • Selection of the test should be based upon – Patients factors – Recognizing each test strength and limitations – Availability

9