Computed tomography coronary angiography for rapid disposition of low-risk emergency department patients with chest pain syndromes.
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.


OBJECTIVE
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.
Hollander
Judd E
JE
Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. hollandj@uphs.upenn.edu
Litt
Harold I
HI
Chase
Maureen
M
Brown
Aaron M
AM
Kim
Woojin
W
Baxt
William G
WG
D006328:Cardiac Catheterization; D002637:Chest Pain / Q000175:diagnosis; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality; D012306:Risk