News | August 06, 2013

Study Shows Coronary CT Angiography Useful for Triaging Patients With Chest Pain

Findings save significant costs, time and unnecessary admissions by ruling out coronary blockages in the ED

heart

August 6, 2013 — A clinical study of two sets of 894 matched emergency department (ED) patients presenting with chest pain revealed that the use of coronary computed tomographic angiography (CCTA) led to fewer hospital admissions and shorter ED stays. According to lead researcher Michael Poon, M.D., of Stony Brook University School of Medicine, the findings provide evidence that CCTA offers an alternative means of improving the triage of chest pain patients.

The paper, “Associations Between Routine Coronary Computed Tomographic Angiography and Reduced Unnecessary Hospital Admissions, Length of Stay, Recidivism Rates, and Invasive Coronary Angiography in the Emergency Department Triage of Chest Pain,” is published online in the August issue of the Journal of the American College of Cardiology

Chest pain is the most common chief complaint in ED patients 65 years and older in the United States. According to the National Health Statistics Report, the symptom leads to more than 6 million ED visits and more than $10 billion in hospital costs per year. The use of CCTA may help emergency room physicians evaluate patients with chest pain. CCTA is a noninvasive heart imaging test that helps determine if fatty or calcium deposits/plaques have narrowed a patient’s coronary arteries. CCTA is a special type of X-ray examination that combines X-ray equipment with sophisticated computer hardware and software to produce high-quality and diagnostic images or pictures of the heart.

Poon and colleagues completed an analysis of data on thousands of Stony Brook patients with chest pain who received either standard evaluation for acute coronary symptoms, which included ED cardiac monitoring with electrocardiograms and blood tests, or CCTA from Jan. 1, 2008, to April 30, 2010. When comparing two matched groups of 894 patients, they found that patients who with standard evaluation had a 5.5 times greater risk for hospital admission and an ED length of stay 1.6 times longer than those who had undergone CCTA. 

The study results also indicated that patients with standard evaluation were seven times more likely to have invasive coronary angiography without revascularization than patients evaluated with CCTA. Additionally, the likelihood of returning to the ED within 30 days for recurrent chest pain in patients with standard evaluation was five times greater, yet there were no differences in the rates of death and acute myocardial infarction within 30 days between the two groups.

Poon said that a major impetus to the study is the lack of widespread CCTA use in emergency settings nationwide to evaluate cardiovascular disease and acute coronary symptoms. He explained that while a variety of issues currently limit the use of CCTA for evaluation of ED patients with chest pain, the most often criticized aspect is the potential for a high radiation dose during the procedure.

“We have developed a low-dose radiation CCTA method that can be safely and effectively used in the ED to evaluate these patients,” Poon said. “With the right technology and experts, CCTA use increases emergency physicians’ ability to accurately and efficiently triage patients with chest pain.”

The study involved CCTA of patients in a setting where CCTA was available 12 hours a day, seven days per week. Patients undergoing computed tomography (CT) were scanned on a 64-slice CT with a median radiation dose of 5.88 mSv compared to 12 mSv of a routine nuclear stress test. Obstructive artery stenosis was defined as 50 percent or greater lumen narrowing. 

For more information: www.onlinejacc.org

Related Content

Proton Therapy Lowers Risk of Side Effects Compared to Conventional Radiation
News | Proton Therapy | May 23, 2019
Cancer patients getting proton therapy instead of traditional photon radiation are at a significantly lower risk of...
VolparaDensity With Tyrer-Cuzick Model Improves Breast Cancer Risk Stratification
News | Breast Density | May 22, 2019
Research has demonstrated use of Volpara Solutions' VolparaDensity software in combination with the Tyrer-Cuzick Breast...
Henry Ford Hospital's ViewRay MRIdian linear accelerator system allows real-time MRI-guided radiotherapy. Shown is the support staff for this system. In the center of the photo is Benjamin Movsas, M.D., chair of radiation oncology at Henry Ford Cancer Institute. Second from the right is Carrie Glide-Hurst, Ph.D., director of translational research, radiation oncology.

Henry Ford Hospital's ViewRay MRIdian linear accelerator system allows real-time MRI-guided radiotherapy. Shown is the support staff for this system. In the center of the photo is Benjamin Movsas, M.D., chair of radiation oncology at Henry Ford Cancer Institute. Second from the right is Carri Glide-Hurst, Ph.D., director of translational research, radiation oncology.

Feature | Henry Ford Hospital | May 21, 2019 | Dave Fornell, Editor
Henry Ford Hospital thought leaders regularly speak at the radiation oncology and radiology conferences about new res
MaxQ AI Launches Accipio Ax Slice-Level Intracranial Hemorrhage Detection
Technology | Computer-Aided Detection Software | May 21, 2019
Medical diagnostic artificial intelligence (AI) company MaxQ AI announced that Accipio Ax will begin shipping in August...
Partial Breast Irradiation Effective, Convenient Treatment Option for Low-Risk Breast Cancer
News | Radiation Therapy | May 20, 2019
Partial breast irradiation produces similar long-term survival rates and risk for recurrence compared with whole breast...
AI Detects Unsuspected Lung Cancer in Radiology Reports, Augments Clinical Follow-up
News | Artificial Intelligence | May 20, 2019
Digital Reasoning announced results from its automated radiology report analytics research. In a series of experiments...
Baylor Scott White Heart Hospital Siemens Flash CT system used for dedicated cardiac CT scans, CCTA, CTA.
360 Photos | CT Angiography (CTA) | May 20, 2019
This is a 360 degree photo of a Siemens Somatom Force 64-slice, dual-source computed tomography (CT) system installed
New Study Evaluates Head CT Examinations and Patient Complexity
News | Neuro Imaging | May 17, 2019
Computed tomography (CT) of the head uses special X-ray equipment to help assess head injuries, dizziness and other...
New Phase 2B Trial Exploring Target-Specific Myocardial Ischemia Imaging Agent
News | Radiopharmaceuticals and Tracers | May 17, 2019
Biopharmaceutical company CellPoint plans to begin patient recruitment for its Phase 2b cardiovascular imaging study in...