scholarly journals Coronary CT angiography for suspected acute coronary syndrome: sex-associated differences

2021 ◽  
Author(s):  
M. Arslan ◽  
J. Schaap ◽  
A. Moelker ◽  
P. P. M. Rood ◽  
E. Boersma ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Obstructive Coronary Artery Disease ◽  
Standard Of Care ◽  
Diagnostic Strategy ◽  
Coronary Syndrome ◽  
Coronary Ct ◽  
Luminal Narrowing ◽  
Artery Disease ◽  
Department Evaluation

Abstract Aim The optimal diagnostic test in the work-up of suspected acute coronary syndrome (ACS) may differ between men and women. The aim of this study was to compare sex-associated differences between using a diagnostic strategy including early coronary computed tomography angiography (CCTA) and standard of care (SOC). Methods In total, 500 patients who presented with symptoms suggestive of ACS at the emergency department were randomised between a diagnostic strategy supplemented with early CCTA and SOC. Results Women were generally older than men (mean ± standard deviation 56 ± 10 vs 53 ± 10 years, p < 0.01) and were less often admitted to hospital (33% vs 44%, p = 0.02). Obstructive coronary artery disease on CCTA (> 50% luminal narrowing) was less frequently seen in women (14% vs 26%, p = 0.02), and ACS was diagnosed less often in women (5% vs 10%, p = 0.03). Women underwent less outpatient testing when early CCTA was used in the emergency department evaluation of suspected ACS (p = 0.008). Conclusion Women had a lower incidence of obstructive CAD on CCTA and were less often admitted to hospital than men. They were subjected to less outpatient testing when early CCTA was used in the emergency department evaluation of suspected ACS.

Abstract 19818: Coronary CT Angiography for Suspected Acute Coronary Syndrome in the Era of High-Sensitivity Troponins - A Randomized Multicenter Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Admir Dedic ◽  
Jeroen Schaap ◽  
Evert Lamfers ◽  
Jeroen Lammers ◽  
Hans Post ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Ct Angiography ◽  
Primary Endpoint ◽  
Coronary Ct Angiography ◽  
High Sensitivity ◽  
Diagnostic Strategy ◽  
Coronary Syndrome ◽  
Coronary Ct ◽  
Number Of Patients

Introduction: It is uncertain whether a diagnostic strategy supplemented by early coronary CT angiography (CCTA) is superior to contemporary standard optimal care (SOC) encompassing high sensitivity troponins for patients suspected of acute coronary syndrome (ACS) in the emergency department. Hypothesis: To assess whether a diagnostic strategysupplemented by early CCTA improves clinical effectiveness compared to contemporary SOC. Methods: In a prospective, open-label, multicentre, randomized trial, we enrolled patients presenting with symptoms suggestive of an ACSat the emergency department (ED) of five community and two university hospitals in the Netherlands. Exclusion criteria included the need for urgent cardiac catheterization, history of ACS or coronary revascularisation. The primary endpoint was the number of patients identified with significant coronary artery disease requiring revascularization within 30 days. Results: The study population consisted of 500 patients of whom 236 (47%) were women (mean age 54±10 years). There was no difference in the primary endpoint (22 [9%] patients underwent coronary revascularizationwithin 30 days in the CCTA group and 17 [7%] in the SOC group [p= 0·40]). Discharge from ED was not more frequent after CCTA (65% versus 59%, p= 0·16) and length of stay was similar(6·3 hours in both groups, p= 0·80). Direct medical costs were lower in the CCTA group (є337 versus є511, p<0·01). Less outpatient testing was seen with CCTA after index ED visit (10 [4%] versus 26 [10%], p<0·01). There was no difference in incidence of undetected ACS. Conclusions: A diagnostic strategy supplemented by early CCTAis safe, less expensive and averts outpatient testing. However, in the era of high-sensitivity troponins, CCTA does not identify more patients with significant CAD requiring coronary revascularization, nor does CCTAshorten hospital stay or allow for more direct discharge from the ED.

Association of Early Stress Testing with Outcomes for Emergency Department Evaluation of Suspected Acute Coronary Syndrome

2016 ◽  
Vol 15 (2) ◽  
pp. 60-68 ◽  
Author(s):  
Benjamin C. Sun ◽  
Amber Laurie ◽  
Rongwei Fu ◽  
Maros Ferencik ◽  
Michael Shapiro ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Stress Testing ◽  
Coronary Syndrome ◽  
Early Stress ◽  
Department Evaluation

Abstract 20047: Validation of the Simple Acute Coronary Syndrome (SACS) Score for Identifying Obstructive Coronary Artery Disease

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Daniel Matta ◽  
Christina Marsalisi ◽  
Wayne Ruppert ◽  
Ravi Korabathina
Keyword(s):  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Cardiac Catheterization ◽  
Obstructive Coronary Artery Disease ◽  
Retrospective Chart Review ◽  
Study Endpoint ◽  
Coronary Syndrome ◽  
Artery Disease ◽  
Scoring Tool

Background: Each year, up to 136,000 individuals suffering from acute coronary syndrome (ACS) are misdiagnosed and discharged from our nations’ emergency departments. We developed the Simple Acute Coronary Syndrome (SACS) score that tabulates a patient’s symptoms, ECG findings, risk factors, and cardiac markers (Figure 1). Our aim was to validate this novel scoring tool in its ability to identify the presence of obstructive coronary artery disease (CAD). Methods: A single-center retrospective chart review was performed after institutional review board approval. The charts of 42 consecutive patients who presented with ACS and who were treated with an invasive strategy were reviewed. Scores were calculated for each patient using the SACS tool as well as the Modified Thrombolysis in Myocardial Infarction (TIMI) ACS calculator. The study endpoint was the presence of at least one vessel obstructive CAD at cardiac catheterization. Descriptive statistics were employed. Results: The stratification of SACS and Modified TIMI scores for each of the 42 ACS patients is shown in Figure 2. In patients with a SACS score that was less than 3, none of these patients were found to have obstructive CAD at cardiac catheterization. For patients with a SACS score of 4 or higher, 100% of these patients were shown to have obstructive CAD. For patients with Modified TIMI scores of 1 and 2, 3/11 (27%) were found to have obstructive CAD. Conclusions: The novel SACS scoring system identifies ACS patients who will have obstructive CAD more reliably than more traditional scoring systems. The SACS scoring tool needs to be validated in larger scale studies.

Novel Emergency Department Risk Score Discriminates Acute Coronary Syndrome Among Chest Pain Patients With Known Coronary Artery Disease

2016 ◽  
Vol 15 (4) ◽  
pp. 138-144 ◽  
Author(s):  
Matthew T. Crim ◽  
Scott A. Berkowitz ◽  
Mustapha Saheed ◽  
Jason Miller ◽  
Amy Deutschendorf ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Coronary Artery ◽  
Risk Score ◽  
Coronary Syndrome ◽  
Artery Disease ◽  
Pain Patients

scholarly journals Early Noninvasive Cardiac Testing After Emergency Department Evaluation for Suspected Acute Coronary Syndrome

2020 ◽  
Vol 180 (12) ◽  
pp. 1621 ◽  
Author(s):  
Aniket A. Kawatkar ◽  
Adam L. Sharp ◽  
Aileen S. Baecker ◽  
Shaw Natsui ◽  
Rita F. Redberg ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Coronary Syndrome ◽  
Department Evaluation ◽  
Cardiac Testing
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