Acute chest pain investigation: Utility of cardiac CT angiography in guiding troponin measurement

Arthur Nasis, Ian Meredith, Nitesh Nerlekar, James Cameron, Paul Antonis, Phillip Mottram, Michael Leung, John Troupis, Marcus Crossett, Anthony Kambourakis, George Braitberg, Udo Hoffmann, Sujith Seneviratne

Research output: Contribution to journalArticleResearchpeer-review

16 Citations (Scopus)

Abstract

To assess the impact on length of stay and rate of major adverse cardiovascular events of a cardiac computed tomographic (CT) angiography-guided algorithm to examine patients who present to the emergency department (ED) with low- to intermediate-risk chest pain. MATERIALS AND METHODS: The study was approved by the institutional review board, and all patients gave written informed consent. Two hundred three consecutive patients (mean age, 55 years +/- 11 [standard deviation]; 123 men) with low- to intermediate-risk ischemic-type chest pain were prospectively enrolled. Patients underwent initial cardiac CT angiography with subsequent treatment determined by reference to findings at cardiac CT angiography; patients without overt plaque were immediately discharged from the hospital, patients with nonobstructive plaque and mild-to-moderate stenoses were discharged after a negative 6-hour troponin level, and patients with severe stenoses were admitted to the hospital. Discharged patients were followed up for a mean of 14.2 months. Additionally, length of stay and safety outcomes among these patients were compared with those in 102 consecutive patients with low- to intermediate-risk chest pain who presented to the ED and underwent a standard of care (SOC) work-up without cardiac CT angiography. One-way analysis of variance with Bonferroni correction was used to compare length of stay between groups. RESULTS: Cardiac CT angiography findings in the 203 patients who underwent cardiac CT angiography were as follows: Sixty-five (32 ) patients had no plaque, 107 (53 ) had nonobstructive plaque, and 31 (15 ) had severe stenoses. At follow-up, there were no deaths or cases of acute coronary syndrome (cardiac CT angiography, 0 , 95 confidence interval [CI]: 0 , 1.85 ; SOC, 0 , 95 CI: 0 , 3.63 ), and the rate of readmission to the hospital because of chest pain was higher with the SOC approach (9 vs 1 , P = .01). Mean ED length of stay was lower with cardiac CT angiograp
Original languageEnglish
Pages (from-to)381 - 389
Number of pages9
JournalRadiology
Volume260
Issue number2
DOIs
Publication statusPublished - 2011

Cite this