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World J Radiol. Feb 28, 2022; 14(2): 30-46
Published online Feb 28, 2022. doi: 10.4329/wjr.v14.i2.30
Acute coronary syndrome on non-electrocardiogram-gated contrast-enhanced computed tomography
Shu Yoshihara
Shu Yoshihara, Department of Diagnostic Radiology, Iwata City Hospital, Iwata 438-8550, Japan
Author contributions: Yoshihara S designed and performed all of this study and wrote the all of the revised manuscript.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shu Yoshihara, MD, PhD, Doctor, Department of Diagnostic Radiology, Iwata City Hospital, 512-3 Ookubo, Iwata 438-8550, Japan. shuy@hospital.iwata.shizuoka.jp
Received: October 18, 2021
Peer-review started: October 18, 2021
First decision: December 10, 2021
Revised: December 14, 2021
Accepted: February 15, 2022
Article in press: February 15, 2022
Published online: February 28, 2022
Processing time: 130 Days and 12.8 Hours
Abstract

It is not rare for acute coronary syndrome (ACS) patients to present with symptoms that are atypical, rather than chest pain. It is sometimes difficult to achieve a definitive diagnosis of ACS for such patients who present with atypical symptoms, normal initial biomarkers of myocardial necrosis, and normal or nondiagnostic electrocardiograms (ECGs). Although cardiac CT allows for assessments of coronary artery stenosis as well as myocardial perfusion defect in patients with suspected ACS, it requires ECG gating and is usually performed with high-performance multislice CT for highly probable ACS patients. However, several recent reports have stated that ACS is detectable by myocardial perfusion defects even on routine non-ECG-gated contrast-enhanced CT. A growing number of contrast-enhanced CT scans are now being performed in emergency departments in search of pathologies responsible for a patient’s presenting symptoms. In order to avoid inappropriate management for this life-threatening event, clinicians should be aware that myocardial perfusion defect is more commonly detectable even on routine non-ECG-gated contrast-enhanced CT performed in search of other pathologies.

Keywords: Acute coronary syndrome, Non-ECG-gated CT, Computed tomography, Myocardial perfusion defect, Emergency department

Core Tip: Definitive diagnosis of acute coronary syndrome (ACS) is sometimes difficult to achieve, especially in patients who present with atypical symptoms, normal initial biomarkers of myocardial necrosis, and normal or nondiagnostic electrocardiograms (ECGs). In order to avoid inappropriate management for this life-threatening event, clinicians should be aware that myocardial perfusion defect is more commonly detectable even on routine non-ECG-gated contrast-enhanced computed tomography performed in search of other pathologies. In this review, several essential points of image interpretation in diagnosing ACS on non-ECG-gated contrast-enhanced computed tomography has been described.