Stress dynamic CT perfusion in the evaluation of acute coronary syndrome

A 61-year-old male patient with cardiovascular risk factors (hypertension, current smoker) presented with chest pain to the emergency department. Non-STEMI (ST elevation myocardial infarction) was diagnosed based on typical complaints and a significant rise in cardiac troponins. No electrocardiographic abnormalities were observed. Patient was pain-free after admission. As part of an observational study, after obtaining informed consent, dynamic cardiac CT perfusion was performed before invasive coronary angiography. Cardiac CT included coronary CTA (CTCA) and dynamic CT stress perfusion after intravenous administration of adenosin. CTCA revealed a thrombus in the mid-LAD (Panel 1) with corresponding perfusion deficit in left anterior descending artery (LAD) territory with hypoperfusion in the following six segments: mid-ventricular anterior, all apical segments and LV apex (Panel 2 and Supplementary material online, Videos S1–S5). Dynamic 4D Computed Tomography Angiography (CTA) reconstructed from the low-dose dynamic perfusion data demonstrated a mid-LAD occlusion with retrograde filling...