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Scherzberg-Doktorczyk, Astrid (2008): Nichtinvasive Koronarangiographie mit Mehrzeilen-Spiral-Computer-Tomographie (MSCT) bei Patienten mit Brustschmerz. Dissertation, LMU München: Medizinische Fakultät



The coronary display within the multislice computer tomography (MSCT) enables an exact insight into the intra-coronary conditions, based on the three dimensional reconstruction of the singular slices. The existence of calcium plaques indicates Arteriosclerosis, but also the pre-stages of calcium, which cannot definitely be diagnosed in percutaneous coronary angiography, can be detected by MSCT due to the distinction of density given in Hounsfield-Units (HU). If the density is below 90 HU the concretion attached to the endothelium is defined as soft plaques, up to 129 HU it is called fibrous and above 130 HU calcium plaques. The non-calcificated pre-stages, also described by Davies as “vulnerable Plaques”, tend to become disrupted even stronger than the relatively solid calcium plaques and therefore are responsible for a bigger part of myocardial infarcts. This prospective clinical trial examines the validity of a prognostic statement concerning the occurrence of acute coronary syndrome caused by plaques related to intra-coronary concretions within a period of six months after a 4-slice MSCT-scanning of the heart. 416 individuals (259 male and 157 female) suffering from chest pain, were observed from May 2001 to December 2002. End points of the study are the incidence of a myocardial infarct, catheter revascularisation or lethality. The sensitivity for the correct prediction of myocardial incidence within the six successive months is evaluated in this study at 97% for the male population and 89% for the female population. The negative prediction is 0.99 for male and 0.98 for female. Despite the representative occurrence of end points of the study and despite that the method is valid and reliable under statistical aspects, the prognostic significance of MSCT has to be treated carefully, also on account of the short examination period of six months. Based on individual diagnostic findings, benefits and future options of MSCT concerning non-invasive heart diagnostics could be demonstrated. In addition to it’s eligibility to control the degree of stenosis of venous and arterial bypasses including the sections of insertion and it’s ability to detect coronary anomalies the MSCT method should provide a calcium mass score according to Hong, to enable the documentation of the plaques progress or expansion.