Coronary Computed Tomographic Angiography for Rapid Discharge of Low-Risk Patients With Potential Acute Coronary Syndromes

Judd E. Hollander, Anna Marie Chang, Frances S. Shofer, Christine M. McCusker, William G. Baxt, Harold I. Litt

Research output: Contribution to journalArticle

124 Citations (Scopus)

Abstract

Study objective: Coronary computed tomographic (CT) angiography has excellent performance characteristics relative to coronary angiography and exercise or pharmacologic stress testing. We hypothesize that coronary CT angiography can identify a cohort of emergency department (ED) patients with a potential acute coronary syndrome who can be safely discharged with a less than 1% risk of 30-day cardiovascular death or nonfatal myocardial infarction. Methods: We conducted a prospective cohort study at an urban university hospital ED that enrolled consecutive patients with potential acute coronary syndromes and a low TIMI risk score who presented to the ED with symptoms suggestive of a potential acute coronary syndrome and received a coronary CT angiography. Our intervention was either immediate coronary CT angiography in the ED or after a 9- to 12-hour observation period that included cardiac marker determinations, depending on time of day. The main clinical outcome was 30-day cardiovascular death or nonfatal myocardial infarction. Results: Five hundred sixty-eight patients with potential acute coronary syndrome were evaluated: 285 of these received coronary CT angiography immediately in the ED and 283 received coronary CT angiography after a brief observation period. Four hundred seventy-six (84%) were discharged home after coronary CT angiography. During the 30-day follow-up period, no patients died of a cardiovascular event (0%; 95% confidence interval [CI] 0% to 0.8%) or sustained a nonfatal myocardial infarction (0%; 95% CI 0 to 0.8%). Conclusion: ED patients with symptoms concerning for a potential acute coronary syndrome with a low TIMI risk score and a nonischemic initial ECG result can be safely discharged home after a negative coronary CT angiography test result.

Original languageEnglish (US)
Pages (from-to)295-304
Number of pages10
JournalAnnals of Emergency Medicine
Volume53
Issue number3
DOIs
StatePublished - Mar 2009
Externally publishedYes

Fingerprint

Acute Coronary Syndrome
Angiography
Hospital Emergency Service
Myocardial Infarction
Observation
Confidence Intervals
Urban Hospitals
Hospital Departments
Coronary Angiography
Electrocardiography
Cohort Studies
Prospective Studies
Exercise

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Coronary Computed Tomographic Angiography for Rapid Discharge of Low-Risk Patients With Potential Acute Coronary Syndromes. / Hollander, Judd E.; Chang, Anna Marie; Shofer, Frances S.; McCusker, Christine M.; Baxt, William G.; Litt, Harold I.

In: Annals of Emergency Medicine, Vol. 53, No. 3, 03.2009, p. 295-304.

Research output: Contribution to journalArticle

Hollander, Judd E. ; Chang, Anna Marie ; Shofer, Frances S. ; McCusker, Christine M. ; Baxt, William G. ; Litt, Harold I. / Coronary Computed Tomographic Angiography for Rapid Discharge of Low-Risk Patients With Potential Acute Coronary Syndromes. In: Annals of Emergency Medicine. 2009 ; Vol. 53, No. 3. pp. 295-304.
@article{878d56c10e494e3681b173674eeb3f68,
title = "Coronary Computed Tomographic Angiography for Rapid Discharge of Low-Risk Patients With Potential Acute Coronary Syndromes",
abstract = "Study objective: Coronary computed tomographic (CT) angiography has excellent performance characteristics relative to coronary angiography and exercise or pharmacologic stress testing. We hypothesize that coronary CT angiography can identify a cohort of emergency department (ED) patients with a potential acute coronary syndrome who can be safely discharged with a less than 1{\%} risk of 30-day cardiovascular death or nonfatal myocardial infarction. Methods: We conducted a prospective cohort study at an urban university hospital ED that enrolled consecutive patients with potential acute coronary syndromes and a low TIMI risk score who presented to the ED with symptoms suggestive of a potential acute coronary syndrome and received a coronary CT angiography. Our intervention was either immediate coronary CT angiography in the ED or after a 9- to 12-hour observation period that included cardiac marker determinations, depending on time of day. The main clinical outcome was 30-day cardiovascular death or nonfatal myocardial infarction. Results: Five hundred sixty-eight patients with potential acute coronary syndrome were evaluated: 285 of these received coronary CT angiography immediately in the ED and 283 received coronary CT angiography after a brief observation period. Four hundred seventy-six (84{\%}) were discharged home after coronary CT angiography. During the 30-day follow-up period, no patients died of a cardiovascular event (0{\%}; 95{\%} confidence interval [CI] 0{\%} to 0.8{\%}) or sustained a nonfatal myocardial infarction (0{\%}; 95{\%} CI 0 to 0.8{\%}). Conclusion: ED patients with symptoms concerning for a potential acute coronary syndrome with a low TIMI risk score and a nonischemic initial ECG result can be safely discharged home after a negative coronary CT angiography test result.",
author = "Hollander, {Judd E.} and Chang, {Anna Marie} and Shofer, {Frances S.} and McCusker, {Christine M.} and Baxt, {William G.} and Litt, {Harold I.}",
year = "2009",
month = "3",
doi = "10.1016/j.annemergmed.2008.09.025",
language = "English (US)",
volume = "53",
pages = "295--304",
journal = "Annals of Emergency Medicine",
issn = "0196-0644",
publisher = "Mosby Inc.",
number = "3",

}

TY - JOUR

T1 - Coronary Computed Tomographic Angiography for Rapid Discharge of Low-Risk Patients With Potential Acute Coronary Syndromes

AU - Hollander, Judd E.

AU - Chang, Anna Marie

AU - Shofer, Frances S.

AU - McCusker, Christine M.

AU - Baxt, William G.

AU - Litt, Harold I.

PY - 2009/3

Y1 - 2009/3

N2 - Study objective: Coronary computed tomographic (CT) angiography has excellent performance characteristics relative to coronary angiography and exercise or pharmacologic stress testing. We hypothesize that coronary CT angiography can identify a cohort of emergency department (ED) patients with a potential acute coronary syndrome who can be safely discharged with a less than 1% risk of 30-day cardiovascular death or nonfatal myocardial infarction. Methods: We conducted a prospective cohort study at an urban university hospital ED that enrolled consecutive patients with potential acute coronary syndromes and a low TIMI risk score who presented to the ED with symptoms suggestive of a potential acute coronary syndrome and received a coronary CT angiography. Our intervention was either immediate coronary CT angiography in the ED or after a 9- to 12-hour observation period that included cardiac marker determinations, depending on time of day. The main clinical outcome was 30-day cardiovascular death or nonfatal myocardial infarction. Results: Five hundred sixty-eight patients with potential acute coronary syndrome were evaluated: 285 of these received coronary CT angiography immediately in the ED and 283 received coronary CT angiography after a brief observation period. Four hundred seventy-six (84%) were discharged home after coronary CT angiography. During the 30-day follow-up period, no patients died of a cardiovascular event (0%; 95% confidence interval [CI] 0% to 0.8%) or sustained a nonfatal myocardial infarction (0%; 95% CI 0 to 0.8%). Conclusion: ED patients with symptoms concerning for a potential acute coronary syndrome with a low TIMI risk score and a nonischemic initial ECG result can be safely discharged home after a negative coronary CT angiography test result.

AB - Study objective: Coronary computed tomographic (CT) angiography has excellent performance characteristics relative to coronary angiography and exercise or pharmacologic stress testing. We hypothesize that coronary CT angiography can identify a cohort of emergency department (ED) patients with a potential acute coronary syndrome who can be safely discharged with a less than 1% risk of 30-day cardiovascular death or nonfatal myocardial infarction. Methods: We conducted a prospective cohort study at an urban university hospital ED that enrolled consecutive patients with potential acute coronary syndromes and a low TIMI risk score who presented to the ED with symptoms suggestive of a potential acute coronary syndrome and received a coronary CT angiography. Our intervention was either immediate coronary CT angiography in the ED or after a 9- to 12-hour observation period that included cardiac marker determinations, depending on time of day. The main clinical outcome was 30-day cardiovascular death or nonfatal myocardial infarction. Results: Five hundred sixty-eight patients with potential acute coronary syndrome were evaluated: 285 of these received coronary CT angiography immediately in the ED and 283 received coronary CT angiography after a brief observation period. Four hundred seventy-six (84%) were discharged home after coronary CT angiography. During the 30-day follow-up period, no patients died of a cardiovascular event (0%; 95% confidence interval [CI] 0% to 0.8%) or sustained a nonfatal myocardial infarction (0%; 95% CI 0 to 0.8%). Conclusion: ED patients with symptoms concerning for a potential acute coronary syndrome with a low TIMI risk score and a nonischemic initial ECG result can be safely discharged home after a negative coronary CT angiography test result.

UR - http://www.scopus.com/inward/record.url?scp=60249088650&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=60249088650&partnerID=8YFLogxK

U2 - 10.1016/j.annemergmed.2008.09.025

DO - 10.1016/j.annemergmed.2008.09.025

M3 - Article

VL - 53

SP - 295

EP - 304

JO - Annals of Emergency Medicine

JF - Annals of Emergency Medicine

SN - 0196-0644

IS - 3

ER -