New Scans May Speed Chest Pain Diagnosis

Dr. James Goldstein stands next to the advance CT scanner at William Beaumont Hospital in Royal Oak, Mich., Friday, Feb. 23, 2007. Dr. Goldstein is the main researcher into ways to diagnose more rapidly whether people who come to the ER with chest pain really are having a heart attack. (AP Photo/Carlos Osorio) (Carlos Osorio - AP)

Beaumont researchers studied 197 chest pain sufferers considered at low risk of a heart attack, giving half the souped-up CT scan. The noninvasive test either ruled in or ruled out heart disease in 75 percent, helping to decide who really needed to be hospitalized 11 hours faster than with routine testing, researchers report in this week's Journal of the American College of Cardiology.

Don't reserve the souped-up CTs for low-risk patients, says Mass General's Hoffmann. He tested the scans in 103 patients, 14 of whom had either a full heart attack or a dangerous condition called unstable angina. The CT scans correctly spotted blocked arteries in those patients, and correctly cleared others who had no or minimal clogs, he reported last fall in the journal Circulation.

So who should get the scans? Hoffmann and the Beaumont group both are preparing larger studies to try to settle that, and to tell if CT angiography improves patients' outcomes or just speeds the diagnosis.

Finding clean arteries or very blocked ones makes for an easy diagnosis. But if the clog is medium-sized, is it causing the chest pain and does it need immediate treatment? A CT alone won't be enough to tell, notes Hoffmann.

Nor is even this noninvasive test risk-free. CT scans do involve radiation, and the injectible dye isn't for people with kidney disease.

While some hospitals already are using the CTs to diagnose chest pain, "most physicians at this time are not familiar with a cardiac CT and what it means," Hoffmann cautions.

For now, just insisting on a thorough check may be the best consumer advice. A disturbing new study of more than 7,000 emergency room visits found blacks and women were less likely to get even that first-step EKG than other chest-pain sufferers. The study couldn't explain the disparity, but lead researcher Liliana Pezzin of the Medical College of Wisconsin suspects harried workers in overcrowded ERs were too quick to assume another cause.

"Be your own advocate," Pezzin says. "Say, 'I need to be tested.'"

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EDITOR'S NOTE _ Lauran Neergaard covers health and medical issues for The Associated Press in Washington.