الفهرس 
ANATOMICAL CONSIDERATIONS OF THE CORONARIES AND GREAT THORACIC VESSELS
Left coronary artery (LCA)Only 14 pages are availabe for public view
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Abstract
Evaluation of chest pain in the Emergency Department
(ED) is a public health issue of great consequence. The
differential diagnosis of chest pain is a complex problem for the
ED physician.
The goal of diagnostic imaging is to triage patients in the
emergency department and allow for safe and rapid discharge
directly from the emergency department after life-threatening
conditions have been excluded.
Recent technologic advances in MDCT have led to notable
improvements in both cardiac and thoracic applications of CT.
ECG-Gated MDCT acute chest pain protocol allow a rapid and
safe discharge in the majority of patients presenting with acute
chest pain and an intermediate risk for ACS while at the same
time identifies those with significant coronary artery stenosis.
In contrast to CCTA, ECG-Gated MDCT acute chest
pain protocol that we used in our study simultaneously
evaluates the pulmonary arteries, entire thoracic aorta, and
additional portions of the adjacent lung zones.
Our study was conducted on 44 patients with nonspecific
acute chest pain. All patients were referred from the
Emergency Department (ED) to the radiology department at
Ain Shams University Hospitals and private centers in East of
Cairo.Our aim was to assess the diagnostic yield and accuracy
of ECG-gated MDCT in the assessment of low and
intermediate risk acute coronary syndrome (ACS) patients
presented with acute chest pain in the ED.
Appropriate patient selection is important for the
effective application of ECG-gated MDCT acute chest pain
protocol. A high negative predictive value, which is useful in
the acute care setting, relies on a patient population with a low
to intermediate risk of ACS, allowing the safe and rapid
discharge of patients directly from the emergency department
after the results of CT evaluation are found to be negative.
Our study estimated the diagnostic accuracy by
comparing our final report with the final diagnosis obtained
after 30 days follow up and the result came up to be sensitivity
of 91.4%, specificity of 100%, positive predictive value of
100% and negative predictive value of 90% with overall
diagnostic accuracy of 93.18%.
These diagnostic values are not significantly different
from those using other techniques for the functional exploration
of myocardial ischemia. clinical data on efficacy and safety did
not discriminate between the different values of coronary CT
angiography, cardiac scintigraphy, and echocardiography or
stress MRI, with ECG-Gated MDCT acute chest pain protocol
having the advantage over CCTA in evaluating other extracardiac
structures and assisting the left ventricular function.