Objective: To evaluate the different patterns of coronary artery disease among patients with unstable angina by the role of multislice CT coronary angiography.
Patients and methods: From September 2013 to May 2014, 40 patients complaining from unstable angina showing initial negative ECG and troponin enzyme underwent a multi-slice CT coronary angiography. Each patient underwent a non-contrast scan to determine the calcium score, then a contrast enhanced ECG gated scan, then the obtained axial images were reconstructed on an advanced workstation. Finally, a systematic analysis of the coronary artery lesions was performed.
Results: 9 patients had normal CTCA, 5 had dense coronary calcification, 16 had no significant obstructive lesion and 10 patients had significant CAD. A total of 60 coronary vessels were found to have plaques. The number of patients with multi-vessel disease was significantly higher than those with single-vessel disease at the time of diagnosis.
Conclusion: Non-invasive multi-slice CT coronary angiography is a reliable technique of high ability to detect coronary artery disease and estimate the degree of obstruction, number of affected arteries and the pattern of their affection and can be used in workup in patients with unstable angina.
The danger, cost and time burden associated with coronary catheter angiography (CCA) suggests a need to develop a noninvasive assessment for patients with suspected coronary artery disease (CAD) especially for those with low probability of disease (1).
The socioeconomic importance of heart disease provides considerable motivation for development of radiologic tools for noninvasive imaging of the coronary arteries (2).
However, during the last 10 years, progressive improvements in the spatial resolution of multi-detector CT (MDCT) allow accurate identification of CAD, thereby offering an alternative to CCA (3).
The rapid rise of coronary computed tomographic (CT) angiography from a research application to widely embraced clinical tool over the last decade has very few parallels in medicine. We currently observe a convergence of factors that has the potential of making coronary CT angiography a pivotal cornerstone in cardiovascular disease management, deserving the highest level of attention of our field (4).
Chest pain is a nonspecific symptom that can have cardiac or non-cardiac causes. The term angina is reserved for pain syndromes arising from presumed myocardial ischemia (5).
Many conditions causing chest pain or discomfort, such as an acute coronary syndrome or angina, have a potentially poor prognosis, emphasizing the importance of prompt and accurate diagnosis (6).
Unstable angina is defined as a new onset chest pain or abrupt deterioration in previously stable angina (7).
It is a clinical syndrome between stable angina and acute myocardial infarction. It typically occurs at rest and has a sudden onset, sudden worsening and recurrence over days and weeks (5).
2. Patients and methods
A total number of 40 patients with unstable angina were scheduled for elective multislice CT coronary angiography between September 2013 and May 2014. All patients came complaining of recent onset of dyspnea on exertion, fatigue on mild effort or ischemic chest pain (defined as retro-sternal heaviness or squeezing sensation that may radiate to the left arm, neck, back or lower jaw, which could be at rest or precipitated by effort, and relieved by rest or sublingual nitrates).
Also the pretest probability of CAD of the American College of Cardiology (ACC) and American Heart Association (AHA) is assessed for all patients based upon the age, gender and the symptoms.
Patients included in our study are 22 males and 18 females, ranging in age between 34 and 79 years, with a mean age of 58.82 years.