CCTA May Be More Effective in Evaluating Women with Acute Chest Pain

Cardiac computed tomographic angiography (CCTA) performed in the emergency department (ED) may be an alternative to standard ED evaluation for women presenting with symptoms suggestive of acute coronary syndromes (ACS). The findings, based on a prespecific subgroup analysis of the Rule-Out Myocardial Infarction with Computer-Assisted Tomography (ROMICAT)-II trial, were published May 17 in Circulation.

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ROMICAT-II was a 1,000-patient, nine-center, U.S.-based randomized comparison of CCTA during an initial ED evaluation for suspected ACS versus standard ED protocols. The primary endpoint was length of stay (LOS), defined as the time from ED presentation to the time of discharge. In this gender-based, prespecific subgroup analysis, LOS among women who underwent CCTA was significantly shorter than among women in the standard evaluation arm (mean 17 vs. 30.7 hours, p<0.0001). Women in the CCTA arm, as compared to men, also had lower hospital admission rates and less cumulative radiation exposure.

The authors suggest the findings are attributable to the lower rate and severity of ACS in women, and that CCTA is an "attractive alternative" to standard evaluation strategies. Nevertheless, they caution, "the small number of major adverse events in this low-intermediate risk sample precludes definitive conclusions as to whether there is a greater benefit for women than men undergoing CCTA. The lack of follow-up beyond 28 days in this trial limits the ability to examine potential longer-term benefits ... [and] the newest CT scanners may not be commonly available."

Moving forward, the authors note that CCTA may be a useful alternative to standard ED evaluation of women with ACS symptoms, but larger trials and more widespread availability of the technology will be needed to determine CCTA's definitive role in ED chest pain protocols.

Clinical Topics: Acute Coronary Syndromes, Noninvasive Imaging

Keywords: Myocardial Infarction, Acute Coronary Syndrome, Follow-Up Studies, Chest Pain, Tomography, Patient Discharge, Length of Stay

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