Early triage of emergency department patients with acute coronary syndrome: contribution of 64-slice computed tomography angiography.
BACKGROUND
Multislice computed tomography coronary angiography (MSCT-CA) is feasible in the emergency department (ED) for ruling out obstructive coronary artery disease (CAD).


OBJECTIVE
To investigate a diagnostic strategy using MSCT-CA for the early triage of patients presenting to the ED with acute chest pain suggestive of acute coronary syndrome (ACS), according to the medium-term incidence of clinical events.


METHODS
We conducted a single-centre, prospective, observational cohort study in 123 patients with low-risk to intermediate-risk acute chest pain suggestive of ACS. MSCT-CA was performed using dual-source 64-slice computed tomography with retrospective electrocardiographic gating. Patients without coronary artery lesions were discharged from the ED. The incidences of death, myocardial infarction and myocardial revascularization were collected during a mid-term follow-up.


RESULTS
According to MSCT-CA, 93 patients (75.6%) had no CAD or coronary artery stenosis less or equal to 50% and 28 patients (22.8%) had stenosis more or equal to 50%. Invasive coronary angiography was performed in 29 patients (23.6%). MSCT-CA accurately identified ten patients (8.13%) with obstructive CAD requiring myocardial revascularization; all had a low TIMI score (0-2) and eight had a low GRACE score. The mean estimated effective dose of MSCT-CA was 16.3±6.4 mSv. Median follow-up was 15 months. No patient (95% CI 0-3.0%) had major adverse cardiovascular events during follow-up.


CONCLUSIONS
MSCT-CA appears to be a useful initial triage tool in the ED. When the MSCT-CA result is negative, it allows safe early discharge because of its high negative predictive value. In a significant number of cases of low-risk ACS, MSCT-CA detects severe coronary lesions and allows further dedicated diagnostic and therapeutic intervention. Reduction of radiation exposure would help acceptance in clinical practice.
Department of Cardiology, University Hospital of Rangueil, 1, avenue Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France. shascoet.cardiotoulouse@yahoo.fr
Sebastien
S
Hascoët
Vanina
V
Bongard
Valerie
V
Chabbert
Marie-Agnes
MA
Marachet
Herve
H
Rousseau
Sandrine
S
Charpentier
Frederic
F
Bouisset
Benjamin
B
Honton
Olivier
O
Lairez
Pauline
P
Marchal
Matthieu
M
Berry
Didier
D
Carrié
Michel
M
Galinier
Meyer
M
Elbaz
D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000209:etiology; D055424:Cardiac-Gated Imaging Techniques; D016507:Cardiology Service, Hospital; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D009203:Myocardial Infarction / Q000209:etiology; D009204:Myocardial Revascularization; D010351:Patient Discharge; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014218:Triage; D055815:Young Adult