title: Cardiac risk factors and risk scores vs cardiac computed tomography angiography: a prospective cohort study for triage of ED patients with acute chest pain.
abstract: OBJECTIVE
  The objective of the study is to evaluate cardiac risk factors and risk scores for prediction of coronary artery disease (CAD) and adverse outcomes in an emergency department (ED) population judged to be at low to intermediate risk for acute coronary syndrome.
  
  
  METHODS
  Informed consent was obtained from consecutive ED patients who presented with chest pain and were evaluated with coronary computed tomography angiography (cCTA). Cardiac risk factors, clinical presentation, electrocardiogram, and laboratory studies were recorded; the Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) scores were tabulated. Coronary computed tomography angiography findings were rated on a 6-level plaque burden scale and classified for significant CAD (stenosis ≥50%). Adverse cardiovascular outcomes were recorded at 30 days.
  
  
  RESULTS
  Among 250 patients evaluated by cCTA, 143 (57%) had no CAD, 64 (26%) demonstrated minimal plaque (<30% stenosis), 26 (10%) demonstrated mild plaque (<50% stenosis), 9 (4%) demonstrated moderate single vessel disease (50%-70% stenosis), 2 (1%) demonstrated moderate multivessel disease, and 6 (2%) demonstrated severe disease (>70% stenosis). Six patients developed adverse cardiovascular outcomes. Among traditional cardiac risk factors, only age (older) and sex (male) were significant independent predictors of CAD. Correlation with CAD was poor for the TIMI (r = 0.12) and GRACE (r = 0.09-0.23) scores. The TIMI and GRACE scores were not useful to predict adverse outcomes. Coronary computed tomography angiography identified severe CAD in all subjects with adverse outcomes.
  
  
  CONCLUSIONS
  Among ED patients who present with chest pain judged to be at low to intermediate risk for acute coronary syndrome, traditional risk factors are not useful to stratify risk for CAD and adverse outcomes. Coronary computed tomography angiography is an excellent predictor of CAD and outcome.
authors.affiliation: Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA. Electronic address: ethan.halpern@jefferson.edu.
authors.forename: Ethan J
authors.initials: EJ
authors.lastname: Halpern
authors.forename: Jacob P
authors.initials: JP
authors.lastname: Deutsch
authors.forename: Maria M
authors.initials: MM
authors.lastname: Hannaway
authors.forename: Adrian T
authors.initials: AT
authors.lastname: Estepa
authors.forename: Anand S
authors.initials: AS
authors.lastname: Kenia
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Neuburger
authors.forename: David C
authors.initials: DC
authors.lastname: Levin
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000000981:diagnostic imaging; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology; D017023:Coronary Angiography / Q000379:methods; D023921:Coronary Stenosis / Q000175:diagnosis / Q000000981:diagnostic imaging; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000175:diagnosis / Q000000981:diagnostic imaging; D011446:Prospective Studies; D012307:Risk Factors; D012723:Sex; D014057:Tomography, X-Ray Computed; D014218:Triage / Q000379:methods; D055815:Young Adult