title: Efficiency and safety of coronary CT angiography compared to standard care in the evaluation of patients with acute chest pain: a Canadian study.
abstract: The optimal assessment of patients with chest pain and possible acute coronary syndrome (ACS) remains a diagnostic dilemma for emergency physicians. Cardiac computed tomographic angiography (CCTA) may identify patients who can be safely discharged home from the emergency department (ED). The objective of the study was to compare the efficiency and safety of CCTA to standard care in patients presenting to the ED with low- to intermediate-risk chest pain. This was a single-center before-after study enrolling ED patients with chest pain and low to intermediate risk of ACS, before and after implementing a cardiac CT-based management protocol. The primary outcome was efficiency (time to diagnosis). Secondary outcomes included safety (30-day incidence of major adverse cardiovascular events (MACE)) and length of stay in the ED. We enrolled 258 patients: 130 in the standard care group and 128 in the cardiac CT-based management group. The cardiac CT group had a shorter time to diagnosis of 7.1 h (IQR 5.8-14.0) compared to 532.9 h (IQR 312.8-960.5) for the standard care group (p < 0.0001) but had a longer length of stay in the ED of 7.9 h (IQR 6.5-10.8) versus 5.5 h (IQR 3.9-7.7) (p < 0.0001). The MACE rate was 1.6 % in the standard care group and 0 % in the cardiac CT group. In conclusion, a cardiac CT-based management strategy to rule out ACS in ED patients with low- to intermediate-risk chest pain was safe and led to a shorter time to diagnosis but increased length of stay in the ED.
authors.affiliation: Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, Ontario, K1Y 4E9, Canada.|Department of Radiology, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada.
authors.forename: Elena
authors.initials: E
authors.lastname: Peña
authors.affiliation: Department of Surgery, Division of Cardiac Surgery, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada.
authors.forename: Fraser
authors.initials: F
authors.lastname: Rubens
authors.affiliation: Department of Emergency Medicine, Ottawa Hospital Research Institute, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, Ontario, K1Y 4E9, Canada.
authors.forename: Ian
authors.initials: I
authors.lastname: Stiell
authors.affiliation: Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, Ontario, K1Y 4E9, Canada.|Department of Radiology, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Peterson
authors.affiliation: Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, Ontario, K1Y 4E9, Canada.|Department of Radiology, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada.
authors.forename: Joao
authors.initials: J
authors.lastname: Inacio
authors.affiliation: Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, Ontario, K1Y 4E9, Canada. cdennie@toh.on.ca.|Department of Radiology, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada. cdennie@toh.on.ca.
authors.forename: Carole
authors.initials: C
authors.lastname: Dennie
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging; D002170:Canada; D002637:Chest Pain / Q000000981:diagnostic imaging*; D000072226:Computed Tomography Angiography; D003287:Contrast Media; D017023:Coronary Angiography; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007472:Iohexol; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment
chemical_list: D003287:Contrast Media; D007472:Iohexol
keywords: Acute coronary syndrome; CT/MRI; Cardiac care; Diagnosis; Efficiency; Imaging; Safety