title: Safety and efficiency of outpatient versus emergency department-based coronary CT angiography for evaluation of patients with potential ischemic chest pain.
abstract: BACKGROUND
  While coronary CT angiography (coronary CTA) may be comparable to standard care in diagnosing acute coronary syndrome (ACS) in emergency department (ED) chest pain patients, it has traditionally been obtained prior to ED discharge and a strategy of delayed outpatient coronary CTA following an ED visit has not been evaluated.
  
  
  OBJECTIVE
  To investigate the safety of discharging stable ED patients and obtaining outpatient CCTA.
  
  
  METHODS
  At two urban Canadian EDs, patients up to 65 years with chest pain but no findings indicating presence of ACS were further evaluated depending upon time of presentation: (1) ED-based coronary CTA during normal working hours, (2) or outpatient coronary CTA within 72 hours at other times. All data were collected prospectively. The primary outcome was the proportion of patients who had an outpatient coronary CTA ordered and had a predefined major adverse cardiac event (MACE) between ED discharge and outpatient CT; secondary outcome was the ED length of stay in both groups.
  
  
  RESULTS
  From July 1, 2012 to June 30, 2014, we enrolled 521 consecutive patients: 350 with outpatient CT and 171 with ED-based CT. Demographics and risk factors were similar in both cohorts. No outpatient CT patients had a MACE prior to coronary CTA. (0.0%, 95% CI 0 to 0.9%) The median length of stay for ED-based evaluation was 6.6 hours (interquartile range 5.4 to 8.3 hours) while the outpatient group had a median length of stay of 7.0 hours (IQR 6.0 to 9.8 hours, n.s.).
  
  
  CONCLUSIONS
  In ED chest pain patients with a low risk of ACS, performing coronary CTA as an outpatient may be a safe strategy.
authors: Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada; Department of Emergency Medicine, Mount St Joseph's Hospital and the University of British Columbia, Vancouver, BC, Canada.
authors: Frank X
authors: FX
authors: Scheuermeyer
authors: Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada.
authors: Brian
authors: B
authors: Grunau
authors: Department of Radiology, St Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada.
authors: Rekha
authors: R
authors: Raju
authors: Department of Radiology, St Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada.
authors: Stephen
authors: S
authors: Choy
authors: Department of Radiology, St Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada.
authors: Christopher
authors: C
authors: Naoum
authors: Department of Radiology, St Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada.
authors: Philipp
authors: P
authors: Blanke
authors: Department of Radiology, St Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada.
authors: Cameron
authors: C
authors: Hague
authors: Division of Cardiology, Department of Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada.
authors: Brett
authors: B
authors: Heilbron
authors: Division of Cardiology, Department of Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada.
authors: Carolyn
authors: C
authors: Taylor
authors: Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada.
authors: Daniel
authors: D
authors: Kalla
authors: Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada.
authors: Jim
authors: J
authors: Christenson
authors: Department of Emergency Medicine, Foothills Hospital and the University of Calgary, Calgary, AB, Canada.
authors: Grant
authors: G
authors: Innes
authors: Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada.
authors: Michaela
authors: M
authors: Hanakova
authors: Department of Radiology, St Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada. Electronic address: jleipsic@providencehealth.bc.ca.
authors: Jonathon
authors: J
authors: Leipsic
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000209:etiology; D000328:Adult; D000553:Ambulatory Care; D000787:Angina Pectoris / Q000000981:diagnostic imaging* / Q000209:etiology; D001955:British Columbia; D016507:Cardiology Service, Hospital; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000209:etiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000209:etiology; D010351:Patient Discharge; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D019037:Urban Health Services
keywords: Coronary CT angiography; Ischemic chest pain