title: Associations between routine coronary computed tomographic angiography and reduced unnecessary hospital admissions, length of stay, recidivism rates, and invasive coronary angiography in the emergency department triage of chest pain.
abstract: OBJECTIVE
  This study was designed to assess the effects on resource utilization of routine coronary computed tomographic angiography (CCTA) in triaging chest pain patients in the emergency department (ED).
  
  
  BACKGROUND
  The routine use of CCTA for ED evaluation of chest pain is feasible and safe.
  
  
  METHODS
  We conducted a retrospective multivariate analysis of data from two risk-matched cohorts of 894 ED patients presenting with chest pain to assess the impact of CCTA versus standard evaluation on admissions rate, length of stay, major adverse cardiovascular event rates, recidivism rates, and downstream resource utilization.
  
  
  RESULTS
  The overall admission rate was lower with CCTA (14% vs. 40%; p < 0.001). Standard evaluation was associated with a 5.5-fold greater risk for admission (odds ratio [OR]: 5.53; p < 0.001). Expected ED length of stay with standard evaluation was about 1.6 times longer (OR: 1.55; p < 0.001). There were no differences in the rates of death and acute myocardial infarction within 30 days of the index visit between the two groups. The likelihood of returning to the ED within 30 days for recurrent chest pain was 5 times greater with standard evaluation (OR: 5.06; p = 0.022). Standard evaluation was associated with a 7-fold greater likelihood of invasive coronary angiography without revascularization (OR: 7.17; p < 0.001), while neither group was significantly more likely to receive revascularization (OR: 2.06; p = 0.193). The median radiation dose with CCTA was 5.88 mSv (n = 1039; confidence interval: 5.2 to 6.4).
  
  
  CONCLUSIONS
  The routine use of CCTA in ED evaluation of chest pain reduces healthcare resource utilization.
authors.affiliation: Department of Radiology, Stony Brook Medicine, State University of New York-Stony Brook University, Stony Brook, NY 11794, USA. michael.poon@stonybrookmedicine.edu
authors.forename: Michael
authors.initials: M
authors.lastname: Poon
authors.forename: Michael
authors.initials: M
authors.lastname: Cortegiano
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Abramowicz
authors.forename: Margaret
authors.initials: M
authors.lastname: Hines
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Singer
authors.forename: Mark C
authors.initials: MC
authors.lastname: Henry
authors.forename: Peter
authors.initials: P
authors.lastname: Viccellio
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Hellinger
authors.forename: Summer
authors.initials: S
authors.lastname: Ferraro
authors.forename: Annie
authors.initials: A
authors.lastname: Poon
authors.forename: Gilbert L
authors.initials: GL
authors.lastname: Raff
authors.forename: Szilard
authors.initials: S
authors.lastname: Voros
authors.forename: Michael E
authors.initials: ME
authors.lastname: Farkouh
authors.forename: Pamela
authors.initials: P
authors.lastname: Noack
mesh_terms: D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000000981:diagnostic imaging*; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods* / Q000706:statistics & numerical data*; D003955:Diagnostic Tests, Routine; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014218:Triage / Q000379:methods*
keywords: ACS; AMI; CAD; CCTA; ECG; ED; MACE; acute coronary syndrome(s); acute myocardial infarction; admission rate; chest pain; coronary artery disease; coronary computed tomographic angiography; electrocardiography; emergency; emergency department; invasive resource utilization; length of stay; major adverse cardiovascular event(s)