BACKGROUND: Patients with recent normal cardiac catheterization are at low risk for complications of ischemic chest pain. Computed tomography (CT) coronary angiography has high correlation with cardiac catheterization for detection of coronary stenosis. Therefore, the investigators' emergency department (ED) incorporated CT coronary angiography into the evaluation of low-risk patients with chest pain. OBJECTIVES: To report on the 30-day cardiovascular event rates of the first 54 patients evaluated by this strategy. METHODS: Low-risk chest pain patients (Thrombolysis In Myocardial Infarction [TIMI] score of 2 or less) without acute ischemia on an electrocardiogram had CT coronary angiography performed in the ED. If the CT coronary angiography was negative, the patient was discharged home. The main outcomes were death and myocardial infarction within 30 days of ED discharge, as determined by telephone follow up and record review. Data are presented as percentage frequency of occurrence with 95% confidence intervals (CIs). RESULTS: Of the 54 patients evaluated, after CT coronary angiography, 46 patients (85%) were immediately released from the ED, and none had cardiovascular complications within 30 days. Eight patients were admitted after CT coronary angiography: one had >70% stenosis, five patients had 50%-69% stenosis, and two had 0-49% stenosis. Three patients had further noninvasive testing; one had reversible ischemia, and catheterization confirmed the results of CT coronary angiography. All patients were followed for 30 days, and none (0; 95% CI = 0 to 6.6%) had an adverse event during index hospitalization or at 30-day follow up. CONCLUSIONS: When used in the clinical setting for the evaluation of ED patients with low-risk chest pain, CT coronary angiography may safely allow rapid discharge of patients with negative studies. Further study to conclusively determine the safety and cost effectiveness of this approach is warranted.
BACKGROUND:Patients with recent normal cardiac catheterization are at low risk for complications of ischemic chest pain. Computed tomography (CT) coronary angiography has high correlation with cardiac catheterization for detection of coronary stenosis. Therefore, the investigators' emergency department (ED) incorporated CT coronary angiography into the evaluation of low-risk patients with chest pain. OBJECTIVES: To report on the 30-day cardiovascular event rates of the first 54 patients evaluated by this strategy. METHODS: Low-risk chest painpatients (Thrombolysis In Myocardial Infarction [TIMI] score of 2 or less) without acute ischemia on an electrocardiogram had CT coronary angiography performed in the ED. If the CT coronary angiography was negative, the patient was discharged home. The main outcomes were death and myocardial infarction within 30 days of ED discharge, as determined by telephone follow up and record review. Data are presented as percentage frequency of occurrence with 95% confidence intervals (CIs). RESULTS: Of the 54 patients evaluated, after CT coronary angiography, 46 patients (85%) were immediately released from the ED, and none had cardiovascular complications within 30 days. Eight patients were admitted after CT coronary angiography: one had >70% stenosis, five patients had 50%-69% stenosis, and two had 0-49% stenosis. Three patients had further noninvasive testing; one had reversible ischemia, and catheterization confirmed the results of CT coronary angiography. All patients were followed for 30 days, and none (0; 95% CI = 0 to 6.6%) had an adverse event during index hospitalization or at 30-day follow up. CONCLUSIONS: When used in the clinical setting for the evaluation of ED patients with low-risk chest pain, CT coronary angiography may safely allow rapid discharge of patients with negative studies. Further study to conclusively determine the safety and cost effectiveness of this approach is warranted.
Authors: Udo Hoffmann; Quynh A Truong; Jerome L Fleg; Alexander Goehler; Scott Gazelle; Stephen Wiviott; Hang Lee; James E Udelson; David Schoenfeld Journal: Am Heart J Date: 2012-02-22 Impact factor: 4.749
Authors: Maros Ferencik; Christopher L Schlett; Fabian Bamberg; Quynh A Truong; John H Nichols; Antonio J Pena; Michael D Shapiro; Ian S Rogers; Sujith Seneviratne; Blair Alden Parry; Ricardo C Cury; Thomas J Brady; David F Brown; John T Nagurney; Udo Hoffmann Journal: Acad Emerg Med Date: 2012-07-31 Impact factor: 3.451
Authors: Ricardo C Cury; Gudrun Feutchner; Constantino S Pena; Warren R Janowitz; Barry T Katzen; Jack A Ziffer Journal: J Nucl Cardiol Date: 2008 Jul-Aug Impact factor: 5.952
Authors: Udo Hoffmann; Fabian Bamberg; Claudia U Chae; John H Nichols; Ian S Rogers; Sujith K Seneviratne; Quynh A Truong; Ricardo C Cury; Suhny Abbara; Michael D Shapiro; Jamaluddin Moloo; Javed Butler; Maros Ferencik; Hang Lee; Ik-Kyung Jang; Blair A Parry; David F Brown; James E Udelson; Stephan Achenbach; Thomas J Brady; John T Nagurney Journal: J Am Coll Cardiol Date: 2009-05-05 Impact factor: 24.094