Frank X Scheuermeyer1, Brian Grunau2, Rekha Raju3, Stephen Choy3, Christopher Naoum3, Philipp Blanke3, Cameron Hague3, Brett Heilbron4, Carolyn Taylor4, Daniel Kalla2, Jim Christenson2, Grant Innes5, Michaela Hanakova2, Jonathon Leipsic6. 1. Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada; Department of Emergency Medicine, Mount St Joseph's Hospital and the University of British Columbia, Vancouver, BC, Canada. 2. Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada. 3. Department of Radiology, St Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada. 4. Division of Cardiology, Department of Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada. 5. Department of Emergency Medicine, Foothills Hospital and the University of Calgary, Calgary, AB, Canada. 6. Department of Radiology, St Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada. Electronic address: jleipsic@providencehealth.bc.ca.
Abstract
BACKGROUND: While coronary CT angiography (coronary CTA) may be comparable to standard care in diagnosing acute coronary syndrome (ACS) in emergency department (ED) chest pain patients, it has traditionally been obtained prior to ED discharge and a strategy of delayed outpatient coronary CTA following an ED visit has not been evaluated. OBJECTIVE: To investigate the safety of discharging stable ED patients and obtaining outpatient CCTA. METHODS: At two urban Canadian EDs, patients up to 65 years with chest pain but no findings indicating presence of ACS were further evaluated depending upon time of presentation: (1) ED-based coronary CTA during normal working hours, (2) or outpatient coronary CTA within 72 hours at other times. All data were collected prospectively. The primary outcome was the proportion of patients who had an outpatient coronary CTA ordered and had a predefined major adverse cardiac event (MACE) between ED discharge and outpatient CT; secondary outcome was the ED length of stay in both groups. RESULTS: From July 1, 2012 to June 30, 2014, we enrolled 521 consecutive patients: 350 with outpatient CT and 171 with ED-based CT. Demographics and risk factors were similar in both cohorts. No outpatient CT patients had a MACE prior to coronary CTA. (0.0%, 95% CI 0 to 0.9%) The median length of stay for ED-based evaluation was 6.6 hours (interquartile range 5.4 to 8.3 hours) while the outpatient group had a median length of stay of 7.0 hours (IQR 6.0 to 9.8 hours, n.s.). CONCLUSIONS: In ED chest pain patients with a low risk of ACS, performing coronary CTA as an outpatient may be a safe strategy.
BACKGROUND: While coronary CT angiography (coronary CTA) may be comparable to standard care in diagnosing acute coronary syndrome (ACS) in emergency department (ED) chest painpatients, it has traditionally been obtained prior to ED discharge and a strategy of delayed outpatient coronary CTA following an ED visit has not been evaluated. OBJECTIVE: To investigate the safety of discharging stable ED patients and obtaining outpatientCCTA. METHODS: At two urban Canadian EDs, patients up to 65 years with chest pain but no findings indicating presence of ACS were further evaluated depending upon time of presentation: (1) ED-based coronary CTA during normal working hours, (2) or outpatient coronary CTA within 72 hours at other times. All data were collected prospectively. The primary outcome was the proportion of patients who had an outpatient coronary CTA ordered and had a predefined major adverse cardiac event (MACE) between ED discharge and outpatientCT; secondary outcome was the ED length of stay in both groups. RESULTS: From July 1, 2012 to June 30, 2014, we enrolled 521 consecutive patients: 350 with outpatientCT and 171 with ED-based CT. Demographics and risk factors were similar in both cohorts. No outpatientCTpatients had a MACE prior to coronary CTA. (0.0%, 95% CI 0 to 0.9%) The median length of stay for ED-based evaluation was 6.6 hours (interquartile range 5.4 to 8.3 hours) while the outpatient group had a median length of stay of 7.0 hours (IQR 6.0 to 9.8 hours, n.s.). CONCLUSIONS: In ED chest painpatients with a low risk of ACS, performing coronary CTA as an outpatient may be a safe strategy.