scholarly journals Coronary CT Angiography in Emergency Department: Can We Use It?

2018 ◽  
Vol 38 (4) ◽  
pp. 234-238
Author(s):  
Sidhi Laksono Purwowiyoto
Keyword(s):  
Emergency Department ◽  
Ct Angiography ◽  
Coronary Ct Angiography ◽  
Acute Chest Pain ◽  
Pain Syndrome ◽  
Low Risk ◽  
Coronary Syndrome ◽  
Coronary Ct ◽  
Risk Patients ◽  
Early Imaging

Acute chest pain syndrome is the main cause of patients come to emergency department. Identifying those with anamneses, risk factors, physical examination, ECG and laboratory remain challenging to exclude the acute coronary syndrome, especially those with low risk probability. Early imaging examination is important for risk stratification of these groups. Utilization of coronary CT angiography quickly identifies a group of low risk patients and allows safe and expedited discharge.   Abstrak Sindroma nyeri dada akut merupakan penyebab utama pasien datang ke unit gawat darurat. Mengidentifikasi mereka dengan anamnesis, faktor risiko, pemeriksaan fisik, EKG dan laboratorium tetap menantang untuk dapat menyingkirkan sindroma koroner akut, terutama yang dengan probabilitas risiko rendah. Pemeriksaan pencitraan awal penting untuk stratifikasi risiko kelompok ini. Penggunaan angiografi CT koroner dengan cepat mengidentifikasi kelompok pasien dengan risiko rendah dan memungkinkan pasien dipulangkan secara aman dan cepat.

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.

CT Angiography for Discharge of Acute Coronary Syndrome

2016 ◽  
Author(s):  
Christoph I. Lee
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Ct Angiography ◽  
Clinical Implications ◽  
Clinical Context ◽  
Additional Information ◽  
Coronary Syndrome ◽  
Coronary Ct ◽  
Risk Patients ◽  
Study Methodology

This chapter, found in the chest pain section of the book, provides a succinct synopsis of a key study examining the use of computed tomography (CT) angiography for discharging patients with acute coronary syndrome from the emergency department. This summary outlines the study methodology and design, major results, limitations and criticisms, related studies and additional information, and clinical implications. The study showed that a negative coronary CT angiography examination can be used to safely expedite the discharge of low-to-intermediate risk patients who present to emergency department with possible acute coronary syndrome. In addition to outlining the most salient features of the study, a clinical vignette and imaging example are included in order to provide relevant clinical context.

Abstract 46: Potential of Coronary CT Angiography to Optimize Medical Therapy in Patients Presenting With Acute Chest Pain

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Amit Pursnani ◽  
Christopher L Schlett ◽  
Pearl Zakroysky ◽  
Parmanand Singh ◽  
James L Januzzi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Secondary Prevention ◽  
Ct Angiography ◽  
Medical Therapy ◽  
Coronary Ct Angiography ◽  
Acute Chest Pain ◽  
Coronary Ct ◽  
Prevention Guidelines ◽  
Pain Patients

Background: Coronary artery disease (CAD) detected by coronary CT angiography (CCTA) independently predicts cardiovascular events. We assessed the potential of CCTA to tailor aspirin (ASA) and statin medical therapy in acute chest pain patients presenting to the emergency department. Methods: We included all patients from the Rule Out Myocardial Infarction Using Computer Assisted Tomography (ROMICAT) Trial. This prospective double-blinded observational cohort study included patients presenting with chest pain to the emergency department with low-intermediate risk for acute coronary syndrome (ACS). Patients underwent CCTA prior to admission, followed by standard evaluation. Caretakers were blinded to CCTA results. We assessed medical therapy at presentation and discharge, and determined concordance of CAD status by CCTA with medical therapy dictated by standard care. Results: Complete data on medical therapy was available in 358/368 patients (99%), (53±12 years, 61% men) of whom 7 had a contraindication to ASA and 11 to statin. Standard of care included stress testing in 71% of patients. Prescription of ASA and statins increased from admission to discharge (See Figure). At discharge, 33% of patients without CAD were on ASA and 14% were on statin. Conversely, 46% of patients with nonobstructive CAD by CCTA did not receive ASA and 59% did not receive statin at discharge. Only 66% of patients with obstructive CAD were on statin and ASA at discharge. Based on 2011 American College of Cardiology/American Heart Association secondary prevention guidelines, there was discordance between CAD status by CCTA and medical therapy in 51% of patients. Conclusions: CCTA has great potential to optimize adherence to secondary prevention guidelines in chest pain patients presenting to the emergency department.

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