Comparing two strategies for emergency department chest pain patients: immediate computed tomography coronary angiography versus delayed outpatient treadmill testing.
Chest pain (CP) is a common emergency department (ED) complaint and return visits (recidivism) are common. Recidivism may be related to incomplete evaluation of a patient's complaint. Computed tomography coronary angiography (CTCA) is accurate for diagnosing coronary artery disease (CAD) in patients with CP. We will compare a strategy of immediate CTCA with a strategy of delayed outpatient stress testing and hypothesize that CTCA will reduce recidivism in patients with CP. We conducted a retrospective cohort study comparing strategies for ED patients with CP: immediate CTCA (CT cohort) versus delayed outpatient stress testing (control cohort). Two hundred eighty subjects were included, 140 in each of the strategies. Recidivism within 6 months of the index ED evaluation occurred in 12 subjects from the CT cohort and 18 subjects from the control cohort (9% vs. 13%, P = 0.41). Duration of stay was increased in the CT cohort (456 vs. 417 min, P = 0.031). Immediate CTCA was associated with improved detection of obstructive CAD (8% vs. 1%, P = 0.005). In conclusion, immediate CTCA, when compared with delayed outpatient stress testing, did not reduce ED recidivism for CP. Length of stay was increased in the immediate CTCA cohort. The use of CTCA improved detection of obstructive CAD.
From the *Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, FL; †Department of Medicine, University of Florida College of Medicine, Gainesville, FL; and ‡Department of Emergency Medicine, University of South Florida College of Medicine, Tampa, FL.
David E
DE
Winchester
Randy
R
Jeffrey
Julio
J
Schwarz
Preeti
P
Jois
D000553:Ambulatory Care; D000787:Angina Pectoris / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis*; D004636:Emergency Service, Hospital; D005080:Exercise Test; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed