title: Efficacy and safety of the computed tomography coronary angiography based approach for patients with acute chest pain at an emergency department: one month clinical follow-up study.
abstract: To evaluate the safety and efficacy of the computed tomography coronary angiography (CTCA) for evaluation of acute chest pain in real world population, we prospectively enrolled 296 patients with acute chest pain at emergency department (ED) from November 2005 to February 2007. The patients were grouped based on the clinical information and CTCA result. The patients with a low risk profile and no significant coronary stenosis (>50%) in CTCA were discharged immediately (Group 1, n=103). On the other hand, the patients with an intermediate risk profile without significant stenosis were observed in ED for 24 hr (Group 2, n=104). The patients with significant stenosis underwent further coronary evaluation and management accordingly (Group 3, n=89). While no false negative case was found in Group 1, seven cases (6.73%) were found in Group 2, mostly during the observation period. In Group 3, there were 54 (60.67%) cases of acute coronary syndrome including 10 myocardial infarctions. The overall accuracy of CTCA for acute coronary syndrome was 88.5% (sensitivity), 85.1% (specificity), 60.7% (positive predictive value) and 96.6% (negative predictive value). In conclusion, clinical decision based on CTCA is safe and effective for low risk patients. Further validation is needed in patients with intermediate risk profile.
authors.affiliation: Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Joonghee
authors.initials: J
authors.lastname: Kim
authors.forename: Hwijae
authors.initials: H
authors.lastname: Lee
authors.forename: Sungwook
authors.initials: S
authors.lastname: Song
authors.forename: Jinsik
authors.initials: J
authors.lastname: Park
authors.forename: Hwanjun
authors.initials: H
authors.lastname: Jae
authors.forename: Whal
authors.initials: W
authors.lastname: Lee
authors.forename: Sangdo
authors.initials: S
authors.lastname: Shin
authors.forename: Sungkoo
authors.initials: S
authors.lastname: Jung
authors.forename: Youngho
authors.initials: Y
authors.lastname: Kwak
authors.forename: Giljoon
authors.initials: G
authors.lastname: Suh
authors.forename: Jaehyung
authors.initials: J
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging; D003657:Decision Making; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*