One-year outcomes following coronary computerized tomographic angiography for evaluation of emergency department patients with potential acute coronary syndrome

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

Research output: Contribution to journalArticle

106 Citations (Scopus)

Abstract

Objectives: Coronary computerized tomographic angiography (CTA) has high correlation with cardiac catheterization and has been shown to be safe and cost-effective when used for rapid evaluation of lowrisk chest pain patients from the emergency department (ED). The long-term outcome of patients discharged from the ED with negative coronary CTA has not been well studied. Methods: The authors prospectively evaluated consecutive low- to intermediate-risk patients who received coronary CTA in the ED for evaluation of a potential acute coronary syndrome (ACS). Patients with cocaine use, known cancer, and significant comorbidity reducing life expectancy and those found to have significant disease (stenosis ≥ 50% or ejection fraction <30%) were excluded. Demographics, medical and cardiac history, labs, and electrocardiogram (ECG) results were collected. Patients were followed by telephone contact and record review for 1 year. The main outcome was 1-year cardiovascular death or nonfatal acute myocardial infarction (AMI). Results: Of 588 patients who received coronary CTA in the ED, 481 met study criteria. They had a mean (±SD) age of 46.1 (±8.8) years, 63% were black or African American, and 60% were female. There were 53 patients (11%) rehospitalized and 51 patients (11%) who received further diagnostic testing (stress or catheterization) over the subsequent year. There was one death (0.2%; 95% confidence interval [CI] = 0.01% to 1.15%) with unclear etiology, no AMI (0%; 95% CI = 0 to 0.76%), and no revascularization procedures (0%; 95% CI = 0 to 0.76%) during this time period. Conclusions: Low- to intermediate-risk patients with a Thrombosis In Myocardial Infarction (TIMI) score of 0 to 2 who present to the ED with potential ACS and have a negative coronary CTA have a very low likelihood of cardiovascular events over the ensuing year.

Original languageEnglish (US)
Pages (from-to)693-698
Number of pages6
JournalAcademic Emergency Medicine
Volume16
Issue number8
DOIs
StatePublished - Aug 2009
Externally publishedYes

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Acute Coronary Syndrome
Hospital Emergency Service
Angiography
Myocardial Infarction
Confidence Intervals
Cardiac Catheterization
Life Expectancy
Chest Pain
Cocaine
Telephone
Catheterization
African Americans
Comorbidity
Electrocardiography
Pathologic Constriction
Thrombosis
History
Demography
Costs and Cost Analysis

Keywords

  • Acute coronary syndrome
  • Chest pain
  • Complications
  • Computerized tomography
  • Observation units
  • Risk stratification

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

One-year outcomes following coronary computerized tomographic angiography for evaluation of emergency department patients with potential acute coronary syndrome. / Hollander, Judd E.; Chang, Anna Marie; Shofer, Frances S.; Collin, Mark J.; Walsh, Kristy M.; McCusker, Christine M.; Baxt, William G.; Litt, Harold I.

In: Academic Emergency Medicine, Vol. 16, No. 8, 08.2009, p. 693-698.

Research output: Contribution to journalArticle

Hollander, Judd E. ; Chang, Anna Marie ; Shofer, Frances S. ; Collin, Mark J. ; Walsh, Kristy M. ; McCusker, Christine M. ; Baxt, William G. ; Litt, Harold I. / One-year outcomes following coronary computerized tomographic angiography for evaluation of emergency department patients with potential acute coronary syndrome. In: Academic Emergency Medicine. 2009 ; Vol. 16, No. 8. pp. 693-698.
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abstract = "Objectives: Coronary computerized tomographic angiography (CTA) has high correlation with cardiac catheterization and has been shown to be safe and cost-effective when used for rapid evaluation of lowrisk chest pain patients from the emergency department (ED). The long-term outcome of patients discharged from the ED with negative coronary CTA has not been well studied. Methods: The authors prospectively evaluated consecutive low- to intermediate-risk patients who received coronary CTA in the ED for evaluation of a potential acute coronary syndrome (ACS). Patients with cocaine use, known cancer, and significant comorbidity reducing life expectancy and those found to have significant disease (stenosis ≥ 50{\%} or ejection fraction <30{\%}) were excluded. Demographics, medical and cardiac history, labs, and electrocardiogram (ECG) results were collected. Patients were followed by telephone contact and record review for 1 year. The main outcome was 1-year cardiovascular death or nonfatal acute myocardial infarction (AMI). Results: Of 588 patients who received coronary CTA in the ED, 481 met study criteria. They had a mean (±SD) age of 46.1 (±8.8) years, 63{\%} were black or African American, and 60{\%} were female. There were 53 patients (11{\%}) rehospitalized and 51 patients (11{\%}) who received further diagnostic testing (stress or catheterization) over the subsequent year. There was one death (0.2{\%}; 95{\%} confidence interval [CI] = 0.01{\%} to 1.15{\%}) with unclear etiology, no AMI (0{\%}; 95{\%} CI = 0 to 0.76{\%}), and no revascularization procedures (0{\%}; 95{\%} CI = 0 to 0.76{\%}) during this time period. Conclusions: Low- to intermediate-risk patients with a Thrombosis In Myocardial Infarction (TIMI) score of 0 to 2 who present to the ED with potential ACS and have a negative coronary CTA have a very low likelihood of cardiovascular events over the ensuing year.",
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T1 - One-year outcomes following coronary computerized tomographic angiography for evaluation of emergency department patients with potential acute coronary syndrome

AU - Hollander, Judd E.

AU - Chang, Anna Marie

AU - Shofer, Frances S.

AU - Collin, Mark J.

AU - Walsh, Kristy M.

AU - McCusker, Christine M.

AU - Baxt, William G.

AU - Litt, Harold I.

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KW - Chest pain

KW - Complications

KW - Computerized tomography

KW - Observation units

KW - Risk stratification

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