title: Coronary computed tomography and triple rule out CT in patients with acute chest pain and an intermediate cardiac risk profile. Part 1: impact on patient management.
abstract: OBJECTIVE
  To evaluate the impact of coronary CT angiography (coronary CTA) or "triple-rule-out" CT angiography (TRO-CTA) on patient management in the work-up of patients with acute chest pain and an intermediate cardiac risk profile.
  
  
  METHODS
  100 patients with acute chest pain and an intermediate cardiac risk for acute coronary syndrome (ACS) underwent coronary CTA or TRO-CTA for the evaluation of chest pain. Patients with a high and low cardiac risk profile were not included in this study. All patients with significant coronary stenosis >50% on coronary CTA underwent invasive coronary catheterization (ICC). Important other pathological findings were recorded. All patients had a 90-day follow-up period for major adverse cardiac events (MACE).
  
  
  RESULTS
  Based on a negative coronary CTA 60 of 100 patients were discharged on the same day. None of the discharged patients showed MACE during the 90-day follow-up. Coronary CTA revealed a coronary stenosis >50% in 19 of 100 patients. ICC confirmed significant coronary stenosis in 17/19 patients. Among the 17 true positive patients, 9 underwent percutaneous coronary intervention with stent implantation, 7 were received intensified medical therapy, and 1 patient underwent coronary artery bypass surgery. A TRO-CTA protocol was performed in 36/100 patients due to elevated d-dimer levels. Pulmonary embolism was present in 5 patients, pleural effusion of unknown etiology in 3 patients, severe right ventricular dysfunction with pericardial effusion in 1 patient, and an incidental bronchial carcinoma was diagnosed in 1 patient.
  
  
  CONCLUSIONS
  Coronary CTA and TRO-CTA allow a rapid and safe discharge in the majority of patients presenting with acute chest pain and an intermediate risk for ACS while at the same time identifies those with significant coronary artery stenosis.
authors: Emergency Department, University Medical Center, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany. joachim.gruettner@umm.de
authors: Joachim
authors: J
authors: Gruettner
authors: Christian
authors: C
authors: Fink
authors: Thomas
authors: T
authors: Walter
authors: Mathias
authors: M
authors: Meyer
authors: Paul
authors: P
authors: Apfaltrer
authors: U Joseph
authors: UJ
authors: Schoepf
authors: Joachim
authors: J
authors: Saur
authors: Tim
authors: T
authors: Sueselbeck
authors: Dominik
authors: D
authors: Traunwieser
authors: Richard
authors: R
authors: Takx
authors: Stefan
authors: S
authors: Kralev
authors: Martin
authors: M
authors: Borggrefe
authors: Stefan O
authors: SO
authors: Schoenberg
authors: Thomas
authors: T
authors: Henzler
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D017023:Coronary Angiography / Q000706:statistics & numerical data*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000628:therapy; D019468:Disease Management; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D015995:Prevalence; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*