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One‐year Outcomes Following Coronary Computerized Tomographic Angiography for Evaluation of Emergency Department Patients with Potential Acute Coronary Syndrome
Author(s) -
Hollander Judd E.,
Chang Anna Marie,
Shofer Frances S.,
Collin Mark J.,
Walsh Kristy M.,
McCusker Christine M.,
Baxt William G.,
Litt Harold I.
Publication year - 2009
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/j.1553-2712.2009.00459.x
Subject(s) - medicine , acute coronary syndrome , emergency department , myocardial infarction , coronary artery disease , chest pain , ejection fraction , cardiology , cardiac catheterization , revascularization , heart failure , psychiatry
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 low‐risk 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.