title: Clinical implementation of an emergency department coronary computed tomographic angiography protocol for triage of patients with suspected acute coronary syndrome.
abstract: OBJECTIVE
  To evaluate the efficiency and safety of emergency department (ED) coronary computed tomography angiography (CTA) during a 3-year clinical experience.
  
  
  METHODS
  Single-center registry of coronary CTA in consecutive ED patients with suspicion of acute coronary syndrome (ACS). The primary outcome was efficiency of coronary CTA defined as the length of hospitalization. Secondary endpoints of safety were defined as the rate of downstream testing, normalcy rates of invasive coronary angiography (ICA), absence of missed ACS, and major adverse cardiac events (MACE) during follow-up, and index radiation exposure.
  
  
  RESULTS
  One thousand twenty two consecutive patients were referred for clinical coronary CTA with suspicion of ACS. Overall, median time to discharge home was 10.5 (5.7-24.1) hours. Patient disposition was 42.7 % direct discharge from the ED, 43.2 % discharge from emergency unit, and 14.1 % hospital admission. ACS rate during index hospitalization was 9.1 %. One hundred ninety two patients underwent additional diagnostic imaging and 77 underwent ICA. The positive predictive value of CTA compared to ICA was 78.9 % (95 %-CI 68.1-87.5 %). Median CT radiation exposure was 4.0 (2.5-5.8) mSv. No ACS was missed; MACE at follow-up after negative CTA was 0.2 %.
  
  
  CONCLUSIONS
  Coronary CTA in an experienced tertiary care setting allows for efficient and safe management of patients with suspicion for ACS.
  
  
  CONCLUSIONS
  • ED Coronary CTA using advanced systems is associated with low radiation exposure. • Negative coronary CTA is associated with low rates of MACE. • CTA in ED patients enables short median time to discharge home. • CTA strategy is characterized by few downstream tests including unnecessary ICA.
authors.affiliation: Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114-2750, USA. bghoshhajra@mgh.harvard.edu.
authors.forename: Brian B
authors.initials: BB
authors.lastname: Ghoshhajra
authors.affiliation: Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114-2750, USA.|Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Richard A P
authors.initials: RAP
authors.lastname: Takx
authors.affiliation: Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114-2750, USA.
authors.forename: Pedro V
authors.initials: PV
authors.lastname: Staziaki
authors.affiliation: Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114-2750, USA.
authors.forename: Harshna
authors.initials: H
authors.lastname: Vadvala
authors.affiliation: Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114-2750, USA.
authors.forename: Phillip
authors.initials: P
authors.lastname: Kim
authors.affiliation: Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114-2750, USA.|Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Tomas G
authors.initials: TG
authors.lastname: Neilan
authors.affiliation: Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114-2750, USA.
authors.forename: Nandini M
authors.initials: NM
authors.lastname: Meyersohn
authors.affiliation: Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114-2750, USA.|Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Medicine 2 - Cardiology, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Bittner
authors.affiliation: Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114-2750, USA.
authors.forename: Sumbal A
authors.initials: SA
authors.lastname: Janjua
authors.affiliation: Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114-2750, USA.|School of Business Studies, Stralsund University of Applied Sciences, Stralsund, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mayrhofer
authors.affiliation: Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Greenwald
authors.affiliation: Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114-2750, USA.|Department of Radiology, Weill Cornell College of Medicine, New York, NY, USA.
authors.forename: Quyhn A
authors.initials: QA
authors.lastname: Truong
authors.affiliation: Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114-2750, USA.|Department Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Suhny
authors.initials: S
authors.lastname: Abbara
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: David F M
authors.initials: DFM
authors.lastname: Brown
authors.affiliation: Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
authors.affiliation: Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114-2750, USA.|Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Francis
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Nagurney
authors.affiliation: Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114-2750, USA.
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D000072226:Computed Tomography Angiography / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D003325:Coronary Care Units; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D014218:Triage / Q000379:methods*
keywords: Cardiovascular diseases; Coronary artery disease; Emergency service; Hospital; Length of stay; Multidetector computed tomography