Abstract 20471: Triage of Chest Pain Patients Presenting to the Emergency Department with Coronary CTA - Implementation in a Large Urban Hospital Healthcare System
Introduction: There is growing evidence supporting the use of Coronary CTA in the emergency department (ED) to triage low to intermediate risk acute chest pain patients. We hypothesize that CTA can guide early patient management and safely discharge patients from the ED.
Methods: We conducted a prospective cohort study in 3 urban hospitals ED part of a large Healthcare system with a total of more than 1300 beds. Patients with negative cardiac enzymes and normal or non-diagnostic EKG with TIMI score = or 70%) were admitted for further work-up. The main clinical outcome was 30-day MACE events. Information of downstream testing was collected and invasive coronary angiography (ICA) was used for comparison with CTA results.
Results: A total of 299 patients (56% females) were evaluated. More than half (n=164/ 55%) had a negative CTA result and were discharged from the ED. 88 patients (29.4%) demonstrated mild disease (1–49%) and were also discharged from the ED with few downstream testing (n=5), confirming negative CTA. 22 patients had moderate stenosis with 17 patients undergoing further testing. 25 patients (8%) had significant stenosis with 19 undergoing ICA, 4 MIBI and 2 both MIBI and ICA. During the 30 days follow-up period no patients discharged from the ED in groups 1 and 2 experienced MACE (0% event rate). The diagnostic accuracy of CTA as compared to ICA was: sens. = 100%, spec. = 96%, NPV = 100% and PPV 66%.
Conclusions: Patients with a negative CTA or mild non-obstructive disease can be safely discharge home from the ED without further testing. On the other end, the accuracy of a positive CTA is high in detecting patients with significant stenosis as compared to ICA.
- © 2010 by American Heart Association, Inc.