title: One-year outcomes following coronary computerized tomographic angiography for evaluation of emergency department patients with potential acute coronary syndrome.
abstract: OBJECTIVE
  Coronary computerized tomographic angiography (CTA) has high correlation with cardiac catheterization and has been shown to be safe and cost-effective when used for rapid evaluation of low-risk chest pain patients from the emergency department (ED). The long-term outcome of patients discharged from the ED with negative coronary CTA has not been well studied.
  
  
  METHODS
  The authors prospectively evaluated consecutive low- to intermediate-risk patients who received coronary CTA in the ED for evaluation of a potential acute coronary syndrome (ACS). Patients with cocaine use, known cancer, and significant comorbidity reducing life expectancy and those found to have significant disease (stenosis > or = 50% or ejection fraction < 30%) were excluded. Demographics, medical and cardiac history, labs, and electrocardiogram (ECG) results were collected. Patients were followed by telephone contact and record review for 1 year. The main outcome was 1-year cardiovascular death or nonfatal acute myocardial infarction (AMI).
  
  
  RESULTS
  Of 588 patients who received coronary CTA in the ED, 481 met study criteria. They had a mean (+/-SD) age of 46.1 (+/-8.8) years, 63% were black or African American, and 60% were female. There were 53 patients (11%) rehospitalized and 51 patients (11%) who received further diagnostic testing (stress or catheterization) over the subsequent year. There was one death (0.2%; 95% confidence interval [CI] = 0.01% to 1.15%) with unclear etiology, no AMI (0%; 95% CI = 0 to 0.76%), and no revascularization procedures (0%; 95% CI = 0 to 0.76%) during this time period.
  
  
  CONCLUSIONS
  Low- to intermediate-risk patients with a Thrombosis In Myocardial Infarction (TIMI) score of 0 to 2 who present to the ED with potential ACS and have a negative coronary CTA have a very low likelihood of cardiovascular events over the ensuing year.
authors: Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. hollandj@uphs.upenn.edu
authors: Judd E
authors: JE
authors: Hollander
authors: Anna Marie
authors: AM
authors: Chang
authors: Frances S
authors: FS
authors: Shofer
authors: Mark J
authors: MJ
authors: Collin
authors: Kristy M
authors: KM
authors: Walsh
authors: Christine M
authors: CM
authors: McCusker
authors: William G
authors: WG
authors: Baxt
authors: Harold I
authors: HI
authors: Litt
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000401:mortality; D017023:Coronary Angiography / Q000379:methods*; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome