Utilization of coronary computed tomography angiography for exclusion of coronary artery disease in ED patients with low- to intermediate-risk chest pain: a 1-year experience
Autor: | Alan F. Vainrib, Amee Minton, Henry C. Thode, Summer Ferraro, Annie Poon, Mark C. Henry, Adam J. Singer, Melissa A. Daubert, Michael Poon, Anna Domingo |
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Rok vydání: | 2012 |
Předmět: |
Male
Chest Pain medicine.medical_specialty medicine.medical_treatment Coronary Artery Disease Coronary Angiography Chest pain Coronary artery disease Risk Factors Interquartile range medicine Humans Prospective Studies Myocardial infarction business.industry General Medicine Thrombolysis Emergency department Middle Aged medicine.disease Hospitalization Stenosis Cohort Emergency Medicine Female Radiology medicine.symptom Emergency Service Hospital Tomography X-Ray Computed business |
Zdroj: | The American Journal of Emergency Medicine. 30:1706-1711 |
ISSN: | 0735-6757 |
DOI: | 10.1016/j.ajem.2012.01.025 |
Popis: | Objective We describe our preliminary experience with coronary computed tomography angiography (CCTA) in emergency department (ED) patients with low- to intermediate-risk chest pain. Methods A convenience cohort of patients with low- to intermediate-risk acute chest pain presenting to a suburban ED in 2009 were prospectively enrolled if the attending physician ordered a CCTA for possible coronary artery disease. Demographic and clinician data were entered into structured data collection sheets required before any imaging. The results of CCTA were classified as normal, nonobstructive (1%-50% stenosis), and obstructive (>50% stenosis). Outcomes included hospital admission and death within a 6-month follow-up period. Results In 2009, 507 patients with ED chest pain had a CCTA while in the ED. The median (interquartile range) age was 54 (47-62) years; 51.5% were female. Thrombolysis in myocardial infarction risk scores were 0 (42.6%), 1 (42.2%), 2 (11.8%), 3 (2.4%), and 4 (1.0%). The results of CCTA were normal (n = 363), nonobstructive (n = 123), and obstructive (n = 21). Admission rates by CCTA results were obstructive (90.5%), nonobstructive (4.9%), and normal (3.0%). None of the patients with normal or nonobstructive CCTA died within the 6-month follow-up period (0%; 95% confidence interval, 0-0.9%). Conclusions Many ED patients with low- to intermediate-risk chest pain have a normal or nonobstructive CCTA and may be safely discharged from the ED without any associated mortality within the following 6 months. |
Databáze: | OpenAIRE |
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