Diagnostic Accuracy of Computed Tomography Angiography in Acute Chest Pain with Suspected Coronary Artery Disease

Abstract

Hypertension, diabetes mellitus, smoking, hyperlipidemia, and familial hypercholesterolemia are major atherosclerotic risk factors and are strongly associated with cardiovascular morbidity and mortality. Coronary artery disease (CAD), most commonly caused by atherosclerotic plaque formation and luminal narrowing of the coronary arteries, remains the leading cause of death worldwide. Coronary computed tomography angiography (CCTA) provides a non-invasive method to assess the anatomic extent and severity of CAD. To determine the frequency and pattern of coronary artery disease detected on computed tomography angiography in patients presenting with chest pain and suspected CAD, and to evaluate its association with major cardiovascular risk factors. This cross-sectional study was conducted over four months at the Punjab Institute of Cardiology, Lahore, and Al-Razi Hospital, Lahore. A total of 67 patients with clinically suspected CAD were enrolled using a consecutive sampling technique. Sample size was calculated using the standard formula with an assumed incidence of CAD of 4.5%. Adults of both genders with suspected CAD, with or without traditional risk factors and/or family history of cardiac disease, were included. Patients aged <18 years and pregnant women were excluded. All patients underwent CCTA on a Toshiba Aquilion 640-slice CT scanner using a standardized contrast-enhanced retrospective ECG-gated protocol. Demographic data, major risk factors (diabetes mellitus, hypertension, hyperlipidemia, familial hypercholesterolemia, smoking), and CCTA findings (presence of CAD and number of vessels involved) were recorded. Data were analyzed using SPSS version 25.  In our Study 67 patients were included in which 51 (76.5%) had CAD and 16 (23.5%) had no CAD on CCTA. The cohort comprised 52 males (78%) and 15 females (22%). Diabetes mellitus was present in 37 patients (54.5%), hypertension in 52 (77.3%), hyperlipidemia in 28 (41.7%), familial hypercholesterolemia in 28 (42%), and smoking in 15 (22.7%). Coronary vessel involvement analysis showed that 16 patients (23.5%) had normal coronary arteries, 10 (15.2%) had single-vessel disease, 10 (15.2%) had two-vessel disease, and 31 (46.2%) had three-vessel disease. The most frequent pattern was combined involvement of LAD + LCA + RCA, observed in 31 patients (46.2%). CAD was more prevalent in males (40 males vs. 11 females with CAD), in diabetics (32 with CAD vs. 5 without), in hypertensive patients (38 with CAD vs. 14 without CAD), in patients with familial hypercholesterolemia (22 with CAD), and in smokers (13 with CAD). Overall, CAD showed higher prevalence among males, diabetics, hypertensive individuals, smokers, and those with familial hypercholesterolemia. CCTA demonstrated a high burden of CAD in patients presenting with chest pain and suspected coronary disease, with most CAD patients exhibiting multivessel involvement. Male gender, hypertension, and diabetes mellitus emerged as the strongest predictors of CAD, while smoking and familial hypercholesterolemia showed weaker associations in this cohort. CCTA is a valuable non-invasive modality for evaluating coronary anatomy and risk stratification in symptomatic patients with multiple cardiovascular risk factors.