Coronary Computed Tomographic Angiography Reduces Chest Pain Admissions

Routine use of coronary computed tomographic angiography (CCTA) in the triage of patients with chest pain presenting to hospital emergency departments (ED) was found to safely reduce the rate of hospital admissions and improve health care resource utilization, according to a study published May 14 in the Journal of the American College of Cardiology.

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The study, from Michael Poon, MD, FACC, Stony Brook University School of Health Technology and Management, Stony Brook, NY, and colleagues retrospectively compared admission rates, length of stay and other measures of resource utilization among 894 patients presenting to the ED of a single medical center who underwent CCTA with a risk-matched cohort of patients who received standard triage. Standard evaluation included serial electrocardiograms (ECGs) and serial blood tests for troponin I levels.

The overall hospital admission rates were 40 percent with standard evaluation versus a significantly lower 14 percent among patients who received CCTA (p<0.001). The length of ED stay was also 1.6 times longer for standard evaluation (11.5 hours versus 7.7 hours, p<0.001). Patients who received standard evaluation were seven times more likely to undergo invasive coronary angiography without revascularization (p≤0.001), but there was no difference between groups in the likelihood of receiving revascularization. The incidence of major adverse coronary events and recidivism also were comparable.

"We conclude that implementation of a protocol for ruling out acute coronary syndromes in low-risk chest pain patients using CCTA will likely increase emergency physicians' abilities to accurately and efficiently triage this common presenting symptom," the authors note. "This may result in a reduction in need for inpatient admissions, ED length of stay, chest pain recidivism rate, downstream evaluation by invasive coronary angiography and enhancing treatment efficacy," they add.

Keywords: Acute Coronary Syndrome, Coronary Angiography, Chest Pain, Hematologic Tests, Electrocardiography, Inpatients, United States, Troponin, Treatment Outcome, Triage, Length of Stay

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