V/Q Scan Lung Tc-99m ventilation-perfusion (V/Q) lung scan may be performed to detect a pulmonary embolism. There is no relevant literature to support the use of V/Q scanning in the evaluation of acute nonspecific chest pain of a cardiac etiology as an initial imaging test. Alternatively, evaluating CCTA versus stress MPI, a randomized controlled single-center study of 400 patients, validated against invasive angiography, documented a comparable length of stay (CCTA 28.9 hours versus MPI 30.1 hours) as well as no differences in major cardiovascular events at 40 months [28]. Another randomized controlled study comparing CCTA with SPECT MPI in 598 participants with low to intermediate risk documented time to diagnosis (CCTA 8.1 hours versus MPI 9.4 hours) and length of stay (CCTA 19.7 hours versus MPI 23.5 hours) (both P = . 002) [29]. The CATCH (CArdiac cT in the treatment of acute CHest pain) trial examined long- term outcomes of CCTA versus standard care in the setting of low-risk acute chest pains in a randomized cohort of 600 participants, with the outcome being MACE at 19 months. Overall occurrence of a primary endpoint was CCTA (n = 16) versus standard care (n = 47) (P = . 04) [30]. A meta-analysis of 37 trials (involving 7,800 patients), compared CCTA, stress echocardiography, and MPI SPECT validated against invasive angiography, or late MACE, in the acute chest pain setting. Weighted mean sensitivity, specificity, positive predictive value, negative predictive value, and total diagnostic accuracy were as follows: CCTA 95%, 99%, 84%, 100%, 99%, respectively; stress echocardiography 84%, 94%, 73%, 96%, 96%, respectively; and SPECT 85%, 86%, 57%, 95%, 88%, respectively. The investigators concluded there was no difference in negative predictive value but that CCTA had superior performance over stress echocardiography and MPI for the other indexes [31].
Acute Nonspecific Chest Pain Low Probability of Coronary Artery Disease PCAs. V/Q Scan Lung Tc-99m ventilation-perfusion (V/Q) lung scan may be performed to detect a pulmonary embolism. There is no relevant literature to support the use of V/Q scanning in the evaluation of acute nonspecific chest pain of a cardiac etiology as an initial imaging test. Alternatively, evaluating CCTA versus stress MPI, a randomized controlled single-center study of 400 patients, validated against invasive angiography, documented a comparable length of stay (CCTA 28.9 hours versus MPI 30.1 hours) as well as no differences in major cardiovascular events at 40 months [28]. Another randomized controlled study comparing CCTA with SPECT MPI in 598 participants with low to intermediate risk documented time to diagnosis (CCTA 8.1 hours versus MPI 9.4 hours) and length of stay (CCTA 19.7 hours versus MPI 23.5 hours) (both P = . 002) [29]. The CATCH (CArdiac cT in the treatment of acute CHest pain) trial examined long- term outcomes of CCTA versus standard care in the setting of low-risk acute chest pains in a randomized cohort of 600 participants, with the outcome being MACE at 19 months. Overall occurrence of a primary endpoint was CCTA (n = 16) versus standard care (n = 47) (P = . 04) [30]. A meta-analysis of 37 trials (involving 7,800 patients), compared CCTA, stress echocardiography, and MPI SPECT validated against invasive angiography, or late MACE, in the acute chest pain setting. Weighted mean sensitivity, specificity, positive predictive value, negative predictive value, and total diagnostic accuracy were as follows: CCTA 95%, 99%, 84%, 100%, 99%, respectively; stress echocardiography 84%, 94%, 73%, 96%, 96%, respectively; and SPECT 85%, 86%, 57%, 95%, 88%, respectively. The investigators concluded there was no difference in negative predictive value but that CCTA had superior performance over stress echocardiography and MPI for the other indexes [31].