title: Utilization of coronary computed tomography angiography for exclusion of coronary artery disease in ED patients with low- to intermediate-risk chest pain: a 1-year experience.
abstract: OBJECTIVE
  We describe our preliminary experience with coronary computed tomography angiography (CCTA) in emergency department (ED) patients with low- to intermediate-risk chest pain.
  
  
  METHODS
  A convenience cohort of patients with low- to intermediate-risk acute chest pain presenting to a suburban ED in 2009 were prospectively enrolled if the attending physician ordered a CCTA for possible coronary artery disease. Demographic and clinician data were entered into structured data collection sheets required before any imaging. The results of CCTA were classified as normal, nonobstructive (1%-50% stenosis), and obstructive (>50% stenosis). Outcomes included hospital admission and death within a 6-month follow-up period.
  
  
  RESULTS
  In 2009, 507 patients with ED chest pain had a CCTA while in the ED. The median (interquartile range) age was 54 (47-62) years; 51.5% were female. Thrombolysis in myocardial infarction risk scores were 0 (42.6%), 1 (42.2%), 2 (11.8%), 3 (2.4%), and 4 (1.0%). The results of CCTA were normal (n = 363), nonobstructive (n = 123), and obstructive (n = 21). Admission rates by CCTA results were obstructive (90.5%), nonobstructive (4.9%), and normal (3.0%). None of the patients with normal or nonobstructive CCTA died within the 6-month follow-up period (0%; 95% confidence interval, 0-0.9%).
  
  
  CONCLUSIONS
  Many ED patients with low- to intermediate-risk chest pain have a normal or nonobstructive CCTA and may be safely discharged from the ED without any associated mortality within the following 6 months.
authors.affiliation: Department of Emergency Medicine, Stony Brook University, Stony Brook, NY, USA. adam.singer@stonybrook.edu
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Singer
authors.forename: Anna
authors.initials: A
authors.lastname: Domingo
authors.forename: Henry C
authors.initials: HC
authors.lastname: Thode
authors.forename: Melissa
authors.initials: M
authors.lastname: Daubert
authors.forename: Alan F
authors.initials: AF
authors.lastname: Vainrib
authors.forename: Summer
authors.initials: S
authors.lastname: Ferraro
authors.forename: Amee
authors.initials: A
authors.lastname: Minton
authors.forename: Annie
authors.initials: A
authors.lastname: Poon
authors.forename: Mark C
authors.initials: MC
authors.lastname: Henry
authors.forename: Michael
authors.initials: M
authors.lastname: Poon
mesh_terms: D002637:Chest Pain / Q000000981:diagnostic imaging*; D017023:Coronary Angiography / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data