Official websites use. Share sensitive information only on official, secure websites. To determine the usefulness of coronary computed tomography angiography CTA in patients with acute chest pain. Observational cohort study in chest pain patients with normal initial troponin and non-ischemic electrocardiogram.
Results were not disclosed. Endpoints were acute coronary syndrome ACS during index hospitalization and major adverse cardiac events MACE during 6- month follow-up. Only one ACS occurred in the absence of calcified plaque. Given the large number of such patients early coronary CTA may significantly improve patient management in the emergency department.
Patients who present with acute chest pain that is believed to be of ischemic origin but who have a normal initial biochemical markers for myocardial necrosis Troponin, Creatinine kinase and normal or non-diagnostic electrocardiograms ECG represent a major diagnostic challenge to emergency departments 1 — 7. Coronary computed tomography angiography CTA is a rapid diagnostic test that has the unique ability to noninvasively and accurately detect significant coronary artery stenoses 11 and coronary atherosclerotic plaque 12 , Several smaller studies suggest that coronary CTA may be helpful to facilitate early triage in patients with acute chest pain 14 — However, the distribution of CT-angiographic findings of coronary artery disease such as plaque and stenosis and their association with ACS is not established.
Such knowledge would provide the basis for the assessment of the clinical utility and the economic implications for using coronary CTA as an early triage tool. Thus, we conducted a prospective observational cohort study to assess the usefulness of coronary CTA in patients with acute chest pain who are being admitted with low to intermediate risk for ACS.
In all patients, ED physicians had sufficient clinical suspicion for an ischemic origin of chest pain and admitted these patients to the hospital to rule out ACS. Notably, patients with a history of established CAD, defined as stent implantation or coronary artery bypass grafting were excluded. Detailed inclusion and exclusion criteria are provided in Table 1. We screened patients who presented with a chief complaint of chest pain to the ED on weekdays from 7am to 7pm May to May All eligible patients who agreed to participate underwent contrast-enhanced coronary CTA prior to admission to the hospital floor.
