CT Angiography for Safe Discharge of Patients with Possible Acute Coronary Syndromes Full Text
Emergency Medicine News, 07/03/2012
Litt HI et al. – Coronary CT angiography, admission, and prolonged observation are not indicated in low–risk chest pain patients in the ED. Perhaps coronary CT angiography will find a use in higher–risk patients as an alternative to cardiac catheterization rather than as an alternative to tried–and–true methods of risk stratification.Methods
- A total of 1,370 subjects were randomized, with 908 assigned to undergo coronary CT angiography while the others received traditional care.
- Patients were followed for 30days to assess clinical outcomes, and the authors collected data on lengths of stay, other cardiac testing, and resource utilization.
- No patient with a negative coronary CT angiogram (640 patients) had an MI or died after 30days, meeting the primary outcome measure of less than one percent of major cardiac events.
- None of the patients in either arm of the study died, and only one percent of the control group patients had an MI within 30days, meaning all patients in the study met the authors' criteria for low risk, regardless of the result of their coronary CT angiogram.
- None of the secondary outcome measures demonstrated any significant difference across groups, although there was a trend toward increased use of cardiac catheterization and of revascularization in the coronary CT angiography group.
- Overall, the rate of medication use among these patients appears to reflect their low–risk status: less than 25 percent were on aspirin and less than 13 percent were on statins at 30–day follow–up.
- The major positive finding promulgated by the authors of this study in promoting coronary CT angiography use was a significant increase in the rate of ED discharge versus hospital or observation unit admission, and a corresponding decrease in total hospital length of stay.
- The median length of stay in the coronary CT angiography group was 18hours overall, decreasing to 12hours in the subset of patients with a negative coronary CT angiogram and to as low as seven hours in the group of patients discharged from the ED.
- The median total length of stay in the traditional care group was 24hours.