Comparison Between Anatomical and Functional Imaging Modalities for Evaluation of Chest Pain in the Emergency Department
| Autor: | Anjani Golive, Faraj Kargoli, Cynthia C. Taub, Durline Brown-Manhertz, Mohammed Makkiya, Linda B. Haramati, Nurilign Bulcha, Mario J. Garcia, Dalvert Polanco, Jeffrey M. Levsky, Mohammad Hashim Mustehsan, Sarah Mizrachi, Andrea Furlani |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Chest Pain Computed Tomography Angiography 030204 cardiovascular system & hematology Chest pain Coronary Angiography 03 medical and health sciences Myocardial perfusion imaging Electrocardiography 0302 clinical medicine Internal medicine Stress Echocardiography Medicine Humans 030212 general & internal medicine Computed tomography angiography Retrospective Studies medicine.diagnostic_test business.industry Myocardial Perfusion Imaging Retrospective cohort study Emergency department Length of Stay Middle Aged Functional imaging Cardiology Female Radiology medicine.symptom Cardiology and Cardiovascular Medicine business Emergency Service Hospital Echocardiography Stress |
| Zdroj: | The American journal of cardiology. 125(12) |
| ISSN: | 1879-1913 |
| Popis: | Evaluation of chest pain in the emergency department (ED) frequently employs a noninvasive strategy, including coronary computed tomography angiography (CCTA), stress echocardiography (SE), or myocardial perfusion imaging (MPI). We sought to report the real-world experience of utilizing CCTA compared with SE and MPI at an urban hospital ED. We conducted a retrospective cohort study of consecutively enrolled patients presenting with chest pain who had normal or nondiagnostic electrocardiogram (ECG), negative initial troponin-T, at least intermediate risk based on modified Diamond-Forrester criteria, and who underwent CCTA, SE, or MPI based on their individual test eligibility criteria. The primary outcome was ED discharge time. Secondary outcomes included test utilization and 30-days rehospitalization rates. The 2,143 patients who were included (mean age was 56 ± 12 years; 55% women) utilization rate (test performed/eligible) was lower for CCTA (n = 354/1,329) and MPI (n = 530/1,435) compared with SE (n = 1,259/1,650), p0.001. Mean ED discharge times for both CCTA and SE were 12.5 ± 7.4 versus 16 ± 7.3 hours for MPI (p0.0001). Patients with SE and CCTA were less likely to undergo coronary angiography (29%, 25%, vs 52% for MPI). There was a 1% cardiac-related 30-days rehospitalization rate in the CCTA group versus 1% in SE and 3% in the MPI group (p0.01). In conclusion, CCTA and SE were associated with faster ED discharge and lower frequency of diagnostic coronary angiography. Notwithstanding its clinical utility, CCTA was underutilized at our large urban ED setting. |
| Databáze: | OpenAIRE |
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