Abstract 18190: Association Between Coronary CT Angiography and Reduced Admissions Rate in Emergency Department Chest Pain in Diabetics
Introduction: Coronary CT Angiography (CCTA) has been shown to safely triage, rule out acute coronary syndrome (ACS), and reduce inpatient resource use in low risk patients presenting to the ED with chest pain. The impact of CCTA as the standard of care (SOC) on resource utilization in diabetics, a high risk ACS population, has not been studied.
Hypothesis: Routine use of CCTA in the ED to evaluate chest pain in diabetics safely reduces in-hospital resource utilization.
Methods: We conducted a retrospective, risk matched, multivariate analysis of two diabetic ED patient cohorts (n=370), who presented with Chest Pain and received CCTA as SOC or our former standard evaluation (SE); measuring hospital admissions, cardiac interventions, recidivism rates, and downstream utilization.
Results: SE patients were 9 times more likely to be admitted or observed (p<0.001), 3 times more likely to undergo invasive coronary angiograms (ICA) (p=0.001) without further intervention, and 5 times more likely to have a stress test (p<0.001). SE patients were 4 times more likely to undergo percutaneous coronary intervention (PCI) on index, but significance was marginal (p=0.052). There was no significant difference in major adverse cardiac events (MACE), return in 30 and 90 days for acute myocardial infarction (AMI), PCI or CABG, p = 0.209, p=0.753, respectively; though CCTA patients tended to experience fewer events. CCTA patients were 2 times more likely to return in 90 days (p=0.004), primarily for non-cardiac encounters (OR=3.40, p =0.004).
Conclusion: CCTA reduced the need for inpatient stay, ICA, and stress testing in diabetics. CCTA’s anatomical information may have reduced the use of PCI in the initial workup for ACS. MACE numbers for CCTA were at least as good as for SE. Improved discharge planning and appropriate outpatient referrals to address medical concerns in these high risk patients may be needed to prevent recurrent ED visits resulting in unnecessary resource utilization.
- Cardiac CT
- Acute coronary syndromes
- Diabetes Mellitus
- Quality of medical care
- Percutaneous coronary intervention (PCI)
Author Disclosures: Z. Kassam: None. K. Lazo: None. P. Noack: None. J. Conroy: None. M. Poon: None.
- © 2016 by American Heart Association, Inc.