Detection of critical coronary artery stenosis through computed tomographic aortogram in patients with suspected aortic dissection

Aim: Computed tomographic aortography (CTA) is standard for aortic dissection (AD) diagnosis, but not commonly used for acute coronary syndromes. In this study, we aimed to investigate the success of CTA in detecting critical stenosis in coronary arteries in patients with non-ST-elevation myocardial infarction (NSTEMI) diagnosed with suspected AD in the emergency department (ED). Material and Methods: This retrospective study was conducted at a tertiary ED from January 2016 to May 2019. Among 6647 acute chest pain patients undergoing CTA for suspected aortic dissection, 50 NSTEMI cases with conventional coronary angiography (CCA) performed were included. Exclusion criteria included age <18, incomplete records, ST elevation on ECG, or confirmed AD on CTA. CTA was performed using a 64-detector CT scanner, and critical stenosis (>50%) in the coronary arteries was evaluated by a radiologist with eight years of cardiothoracic imaging experience. Results: In this study, 200 coronary arteries of 50 patients were analyzed. Among the 50 patients included in the study, 29 (58%) were male and 21 (42%) female, with a mean age of 61.4 +/- 14.1 years. CTA exhibited a high specificity of 98.71% and sensitivity of 88.89% in detecting critical stenosis within the coronary arteries. A statistically significant positive correlation was observed between the imaging findings of CTA and those of CCA (p<0.001). Discussion: The results indicate that CTA is comparably effective to CCA in identifying critical stenosis within coronary arteries. Moreover, CTA demonstrates potential as an early diagnostic tool for identifying patients with NSTEMI in the ED.