Abstract 2943: Utility of Multi-Slice Computed Tomographic Angiography in the Emergency Department
BACKGROUND: An estimated 700,000 Americans will have a new onset of acute coronary syndrome each year while approximately 500,000 will have recurrent attacks. Many of these patients will present in Emergency Departments (ED) taxing healthcare systems with expensive resources and throughput issues.
OBJECTIVES: The purpose of this study is to assess the use of 64-slice MDCT (CCTA) in patients who present in the ED with acute chest pain. End points were measurement of cardiac events, resource utilization, and throughput (LOS).
METHODS: This is a prospective study enrolling patients in a 4 month period who presented to the ED with atypical chest pain without elevated troponin levels, abnormal ECG and/or known history of CAD. Patients enrolled in the study were then assessed for BMI and heart rate and divided into Cohort A (CCTA eligible, N=51) or Cohort B (no CCTA due to heart rate >70 or BMI >40 and admitted overnight for stress test; N=25). Those patients included in both cohorts were followed up by telephone call 30 and 90 days after discharge. The AHA/ACC segment model was used to assess the degree and location of stenosis. Lesions were classified as Grade I 0 –25%, Grade II 25–50%, Grade III 50 –70%, and grade IV >70%. Normal or Grade I lesions were discharged from the hospital.
RESULTS: Seventy-six patients were enrolled into the study and divided into two cohorts. Patients’ ages ranged from 21 to 65 with a mean age of 43 and a gender ratio of 48% women. In Cohort A, 37 patients (72%) had a normal CCTA study, 13 patients (25%) had Grade I lesions, 1 patient (3%) had a Grade II/III lesion, and no patients had a grade IV lesion. In Cohort B, 10 patients had a negative stress test and 15 patients were monitored overnight. On telephone follow up, no deaths or cardiac events occurred. The average hospital length of stay (LOS) for patients in Cohort A was 13 hours accumulating $8,000 in charges which was significantly reduced compare to patients in Cohort B who had an LOS of 32 hours and accumulated charges of $13,000 (LOS P=0.0059; charges P=0.0015).
CONCLUSION: 64-slice MDCT is a useful tool to evaluate low risk patients presenting with atypical chest pain in the ED resulting in not only a safe discharge but a significant reduction in both length of stay and in accumulated charges.