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

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

Houston Methodist Hospital Enters Multi-Year Technology and Research Agreement With Siemens Healthineers
News | Imaging | August 17, 2017
Houston Methodist Hospital and Siemens Healthineers have entered into a multi-year agreement to bring cutting-edge...
X-ray of a knee replacement. CMS may change reimbursements for joint and knee replacements. Patient Marilyn Fornell.

CMS may change how it reimburses for knee replacements and said it may eliminate bundled payments for acute cardiac care.

Feature | Business | August 16, 2017 | Dave Fornell
August 16, 2017 — The Centers for Medicare and Medicaid Services (CMS) announced a proposed rule to reduce the number
Four Blue Cross Blue Shield Companies Issue Positive Medical Policies on HeartFlow FFRct Analysis
News | Computed Tomography (CT) | August 09, 2017
HeartFlow Inc. announced that four Blue Cross Blue Shield companies have each issued a positive medical policy for the...
MRI Reveals Striking Brain Differences in People with Genetic Autism

Example images for a control participant , a deletion carrier, and a duplication carrier. In the sagittal image of the deletion carrier, the thick corpus callosum, dens and craniocervical abnormality, and cerebellar ectopia are shown. For the duplication carrier, the sagittal image shows the thin corpus callosum and the axial image shows the increased ventricle size and decreased white matter volume. Image courtesy of the Radiological Society of North America (RSNA).

News | Neuro Imaging | August 09, 2017
August 9, 2017 — In the first major study of its kind, researchers using magnetic...
Moffitt Cancer Center Enhances Patient Care with Toshiba Medical's Infinix-i 4-D
News | Interventional Radiology | August 03, 2017
Cancer patients at Moffitt Cancer Center in Tampa, Fla., now have access to advanced diagnostic imaging for fast and...
Clinical Data Supports Use of Xoft System for Endometrial Cancer
News | Brachytherapy Systems | August 03, 2017
Researchers presented clinical data supporting use of the Xoft Axxent Electronic Brachytherapy (eBx) System for the...
brain with chronic traumatic injury
News | Magnetic Resonance Imaging (MRI) | August 02, 2017
Fighters are exposed to repeated mild traumatic brain injury (mTBI), which has been associated with neurodegenerative...
The American Lung Association created LUNG FORCE, a national movement to defeat lung cancer
News | Lung Cancer | August 02, 2017
To raise public awareness of lung cancer—the leading cancer killer of men and women—the American Lung Association's...
GE’s DoseWatch is a digital informatics solution that automatically collects, monitors and reports on radiation dose indices for diagnostic imaging exams
News | Radiation Dose Management | July 31, 2017
GE Healthcare announced that it has licensed computed tomography (CT) organ dosimetry technology developed at Duke...
NIH-funded scientists have discovered that Parkinson’s disease increases the amount of “free” water in a particular brain area

NIH-funded scientists have discovered that Parkinson’s disease increases the amount of “free” water in a particular brain area. Image courtesy of David Vaillancourt, Ph.D., University of Florida.

News | Neuro Imaging | July 31, 2017
Scientists at the University of Florida have discovered a new method of observing the brain changes caused by Parkinson...
Overlay Init