Abstract 19376: Coronary CT Angiography Performed in the Emergency Department in Chest Pain Patients is Effective in Identifying Patients who Require Revascularization

Abstract

Introduction: The high sensitivity and negative predictive value of coronary CT angiography (CCTA) has been demonstrated in several multi-center studies; however little is known about downstream evaluation and revascularization in patients admitted to the hospital based on CCTA. We hypothesized that CCTA would be an effective testing modality in identifying patients with obstructive coronary artery disease (CAD) requiring revascularization.

Methods: We performed a retrospective study of consecutive low-risk patients (TIMI risk score 3 or less) undergoing CCTA in the ED for chest pain during a 6-month period. CCTA was performed using institutional protocols; stenoses were graded semi-quantitatively as none, mild, moderate or severe; most severe lesion per patient was recorded. Downstream non-invasive and invasive evaluation and revascularization via either percutaneous coronary intervention or coronary artery bypass graft was extracted from charts.

Results: There were 902 patients who had a CCTA study performed in the ER, of which 105 (11.6%) were admitted for further testing. Non-invasive testing was the initial strategy in 60% and angiography in 40% of patients (Figure). Of those with normal or mild stenosis, only 2 of 11 had revascularization. Of those with intermediate stenosis, 14 out of 65 (21.5%), and of those with severe stenosis, 22 of 29 (75.9%) required revascularization. In multivariate analysis, clinical characteristics did not, but stenosis severity by CCTA predicted revascularization (OR 3.53, 95% CI:1.59-7.80).

Conclusion: CCTA appears to be an effective tool in triaging low-risk patients for downstream evaluation and revascularization procedures.