Abstract 6102: Integration of Non-Contrast Cardiac Computed Tomography and Stress Myocardial Perfusion Imaging in the Emergency Department: Identifying Which Patients with Chest Pain Can be Safely Discharged Home
| Autor: | Faisal Nabi, Su Min Chang, Lemuel A Moye, Robert G Hust, Craig M Pratt, John J Mahmarian |
|---|---|
| Rok vydání: | 2008 |
| Předmět: | |
| Zdroj: | Circulation. 118 |
| ISSN: | 1524-4539 0009-7322 |
| DOI: | 10.1161/circ.118.suppl_18.s_1061-c |
| Popis: | Over 5 million emergency department (ED) visits occur annually for evaluation of chest pain. A rapid simple imaging algorithm is needed to identify patients with noncardiac chest pain so as to avoid unnecessary hospital admission. We conducted a prospective trial in 1031 low risk patients (60% women; mean age 54±13 years) admitted through the ED to our chest pain unit who had no prior cardiac history, a nondiagnostic ECG for ischemia, and a normal initial troponin. All patients had stress myocardial perfusion imaging (SPECT) with a coronary artery calcium score (CACS) by noncontrast cardiac computed tomography (CT) within 24 hours. Mean patient follow-up was 7.4±3.3 months. SPECT and CT studies were interpreted independently and the CACS quantified as an Agatston score. The mean TIMI risk score was 1.5±0.7. Cardiac events occurred in 29 patients (2.8%): acute myocardial infarction (N=4) or an acute coronary syndrome (ACS, N=21) during admission; or ACS following hospital discharge (N=4). Abnormal SPECT and cardiac events significantly increased with CACS (p400 vs 0(Table ). Only 5 (0.8%) patients with CACS=0 had an abnormal SPECT and none had significant coronary artery disease by angiography. The 2 patients who had a CACS=0 and a cardiac event during their hospitalization both had a normal gated SPECT and no subsequent event in follow-up. The sensitivity of an abnormal CT was significantly higher than an abnormal SPECT for identifying patients with events (93% vs 65%, p |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|