Coronary computed tomographic angiography for rapid discharge of low-risk patients with potential acute coronary syndromes.
Publication/Presentation Date
3-1-2009
Abstract
STUDY OBJECTIVE: Coronary computed tomographic (CT) angiography has excellent performance characteristics relative to coronary angiography and exercise or pharmacologic stress testing. We hypothesize that coronary CT angiography can identify a cohort of emergency department (ED) patients with a potential acute coronary syndrome who can be safely discharged with a less than 1% risk of 30-day cardiovascular death or nonfatal myocardial infarction.
METHODS: We conducted a prospective cohort study at an urban university hospital ED that enrolled consecutive patients with potential acute coronary syndromes and a low TIMI risk score who presented to the ED with symptoms suggestive of a potential acute coronary syndrome and received a coronary CT angiography. Our intervention was either immediate coronary CT angiography in the ED or after a 9- to 12-hour observation period that included cardiac marker determinations, depending on time of day. The main clinical outcome was 30-day cardiovascular death or nonfatal myocardial infarction.
RESULTS: Five hundred sixty-eight patients with potential acute coronary syndrome were evaluated: 285 of these received coronary CT angiography immediately in the ED and 283 received coronary CT angiography after a brief observation period. Four hundred seventy-six (84%) were discharged home after coronary CT angiography. During the 30-day follow-up period, no patients died of a cardiovascular event (0%; 95% confidence interval [CI] 0% to 0.8%) or sustained a nonfatal myocardial infarction (0%; 95% CI 0 to 0.8%).
CONCLUSION: ED patients with symptoms concerning for a potential acute coronary syndrome with a low TIMI risk score and a nonischemic initial ECG result can be safely discharged home after a negative coronary CT angiography test result.
Volume
53
Issue
3
First Page
295
Last Page
304
ISSN
1097-6760
Published In/Presented At
Hollander, J. E., Chang, A. M., Shofer, F. S., McCusker, C. M., Baxt, W. G., & Litt, H. I. (2009). Coronary computed tomographic angiography for rapid discharge of low-risk patients with potential acute coronary syndromes. Annals of emergency medicine, 53(3), 295–304. https://doi.org/10.1016/j.annemergmed.2008.09.025
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
18996620
Department(s)
Administration and Leadership
Document Type
Article