Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Aug 28, 2022; 14(8): 311-318
Published online Aug 28, 2022. doi: 10.4329/wjr.v14.i8.311
Triple rule-out computed tomography angiography: Evaluation of acute chest pain in COVID-19 patients in the emergency department
Suzan Bahadir, Sonay Aydın, Mecit Kantarci, Edhem Unver, Erdal Karavas, Düzgün Can Şenbil
Suzan Bahadir, Department of Radiology, Baskent University, Antalya 07000, Turkey
Sonay Aydın, Erdal Karavas, Düzgün Can Şenbil, Department of Radiology, Erzincan Binali Yıldırım University, Erzincan 24100, Turkey
Mecit Kantarci, Department of Radiology, Ataturk University, Erzurum 25100, Turkey
Edhem Unver, Department of Chest Disease, Erzincan Binali Yildirim University, Erzincan 24100, Turkey
Author contributions: Aydın S, Bahadır S, Kantarcı M, and Karavas E designed the research study; Bahadır S, Ünver E, Şenbil DC, and Karavas E performed the research; Aydın S and Bahadır S contributed new reagents and analytic tools; Aydın S, Karavas E, and Şenbil DC analyzed the data and wrote the manuscript; all authors have read and approved the final manuscript.
Institutional review board statement: This study was approved by our Institutional Review Board (Erzincan Binali Yıldrım University Faculty of Medicine protocol number kaek-ebyu-2020/03/14) and as it was a retrospective study, written informed consent was waived.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: No author has any conflict of interest to declare in this study.
Data sharing statement: No additional data are available.
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: Düzgün Can Şenbil, MD, Academic Research, Doctor, Department of Radiology, Erzincan Binali Yıldırım University, Hacı Ali Akın Street, Erzincan 24100, Turkey. can.senbil@erzincan.edu.tr
Received: April 11, 2022
Peer-review started: April 11, 2022
First decision: May 30, 2022
Revised: May 30, 2022
Accepted: August 5, 2022
Article in press: August 5, 2022
Published online: August 28, 2022
Processing time: 135 Days and 20.5 Hours
Abstract
BACKGROUND

The aim of this study was to define clinical evidence supporting that triple rule-out computed tomography angiography (TRO CTA) is a comprehensive and feasible diagnostic tool in patients with novel coronavirus disease 2019 (COVID-19) who were admitted to the emergency department (ED) for acute chest pain. Optimizing diagnostic imaging strategies in COVID-19 related thromboembolic events, will help for rapid and noninvasive diagnoses and results will be effective for patients and healthcare systems in all aspects.

AIM

To define clinical evidence supporting that TRO CTA is a comprehensive and feasible diagnostic tool in COVID-19 patients who were admitted to the ED for acute chest pain, and to assess outcomes of optimizing diagnostic imaging strategies, particularly TRO CTA use, in COVID-19 related thromboembolic events.

METHODS

TRO CTA images were evaluated for the presence of coronary artery disease, pulmonary thromboembolism (PTE), or acute aortic syndromes. Statistical analyses were used for evaluation of significant association between the variables. A two tailed P-value < 0.05 was considered statistically significant.

RESULTS

Fifty-three patients were included into the study. In 31 patients (65.9%), there was not any pathology, while PTE was diagnosed in 11 patients. There was no significant relationship between the rates of pathology on CTA and history of hypertension. On the other hand, the diabetes mellitus rate was much higher in the acute coronary syndrome group, particularly in the PTE group (8/31 = 25.8% vs 6/16 = 37.5%, P = 0.001). The rate of dyslipidemia was significantly higher in the group with pathology on CTA while compared to those without pathology apart from imaging findings of the pneumonia group (62.5% vs 38.7%, P < 0.001). Smoking history rates were similar in the groups. Platelets, D-dimer, fibrinogen, C-reactive protein, and erythrocyte sedimentation rate values were higher in COVID-19 cases with additional pathologies.

CONCLUSION

TRO CTA is an effective imaging method in evaluation of all thoracic vascular systems at once and gives accurate results in COVID-19 patients.

Keywords: COVID-19; Pulmonary thromboembolism; Coronary artery disease; Acute aortic syndromes; Triple rule-out computed tomography angiography

Core Tip: Acute chest pain might be due to pneumonia itself or accompanying vascular events in novel coronavirus disease 2019 (COVID-19) cases. Triple rule-out computed tomography angiography (TRO CTA) is an effective and non-invasive diagnostic method in COVID-19 patients who were admitted to the emergency department with acute chest pain. TRO CTA is an imaging method that evaluates all thoracic vascular systems at once and gives accurate results in the COVID-19 patient group with acute chest pain, which has been proven to be susceptible to thrombotic events.