Usefulness of 64-slice multidetector computed tomography as an initial diagnostic approach in patients with acute chest pain.
BACKGROUND
Recently, multidetector computed tomography (MDCT) has been proposed as an accurate diagnostic tool to evaluate for coronary artery disease. However, the role of MDCT as part of the initial diagnostic for evaluating acute chest pain is less well established.


METHODS
We prospectively enrolled patients presenting with acute chest pain to the emergency department (ED) and risk stratified them based on the pretest probability for an acute coronary syndrome (ACS): (1) very low, (2) low, (3) intermediate, (4) high, and (5) very high or definite. After exclusion of very low and very high risk patients, 268 patients were randomized to either immediate 64-slice cardiac MDCT or a conventional diagnostic strategy. Number of admissions, ED and hospital length of stay (LOS), and major adverse cardiac events over 30 days of follow-up were compared between the strategies based on the pretest probability for ACS.


RESULTS
The number of patients ultimately diagnosed with an ACS did not differ between the 2 strategies. Emergency department LOS and total admissions were not different between strategies. Patients in the MDCT-based strategy had a decreased hospital LOS (P = .049) and fewer admissions deemed unnecessary (P = .007). Reductions in unnecessary admissions were more prominent in intermediate-risk patients (P = .015). None of the patients discharged from the ED in the MDCT-based strategy experienced major adverse cardiac events at follow-up.


CONCLUSIONS
Use of an MDCT-based strategy in the ED as part of the initial diagnostic approach for patients presenting with acute chest pain is safe and efficiently reduces avoidable admissions in patients with an intermediate pretest probability for ACS.
Chang
Sung-A
SA
Division of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seoul, Republic of Korea.
Choi
Sang Il
SI
Choi
Eue-Keun
EK
Kim
Hyung-Kwan
HK
Jung
Jin-Wook
JW
Chun
Eun Ju
EJ
Kim
Kyu-Seok
KS
Cho
Young-Seok
YS
Chung
Woo-Young
WY
Youn
Tae-Jin
TJ
Chae
In-Ho
IH
Choi
Dong-Ju
DJ
Chang
Hyuk-Jae
HJ
D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000000981:diagnostic imaging*; D002637:Chest Pain / Q000209:etiology*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*