Screening patients with chest pain in the emergency department using electron beam tomography: a follow-up study
D Georgiou1, M J Budoff, E Kaufer
1Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, New York, USA.
Insights
Electron beam tomography (EBT) effectively detects coronary artery calcium (CAC) in patients with chest pain, predicting future cardiac events. Absence of CAC indicates a very low risk of future cardiac events over seven years.
Area of Science:
- Cardiology
- Radiology
- Preventive Medicine
Background:
- Electron beam tomography (EBT) is a rapid screening tool for chest pain patients in emergency departments.
- Limited long-term follow-up data exists for chest pain patients screened with EBT.
Purpose of the Study:
- To investigate the association between coronary artery calcium (CAC) detection using EBT and future cardiac events in hospitalized patients with acute chest pain syndromes.
- To assess the prognostic value of CAC in a symptomatic cohort.
Main Methods:
- A prospective observational study involving 221 patients admitted to the emergency department for chest pain syndromes.
- Patients underwent EBT scanning in addition to standard care.
- Long-term follow-up (average 50 months) was conducted via chart review.
Main Results:
- The presence and increasing quartiles of CAC scores were strongly associated with hard cardiac events (myocardial infarction, death) and all cardiovascular events (p < 0.001).
- Age- and gender-matched CAC scoring significantly improved prognostic ability (OR: 13.1).
- Fifty-eight patients experienced confirmed coronary events.
Conclusions:
- The presence of CAC in symptomatic patients is a strong predictor of future cardiac events.
- EBT is valuable for risk stratification in symptomatic cohorts, enabling prompt discharge for those with negative scans.
- Absence of CAC is linked to a very low risk (<1% annual event rate) of future cardiac events over seven years.
Objectives:
The high sensitivity of electron beam tomography (EBT) in the detection of coronary artery calcium (CAC) and obstructive coronary artery disease prompted us to investigate the association between CAC detection and future cardiac events in patients with acute chest pain syndromes requiring hospitalization.
Background:
Three studies have documented that EBT is a rapid and efficient screening tool for patients admitted to the emergency department (ED) with chest pain, but there is a paucity of long-term follow-up data on these chest pain patients.
Methods:
We conducted a prospective observational study of 192 patients admitted to the ED of a large tertiary care hospital for chest pain syndromes. Upon admission, patients underwent EBT scanning in addition to the usual care for chest pain syndromes. During the 17-month enrollment period, 221 patients were scanned (54% men with a mean age of 53 +/- 9 years). Average follow-up was 50 +/- 10 months using chart review.
Results:
Fifty-eight patients had coronary events confirmed by a blinded medical record review. The presence of CAC (a total calcium score >0) and increasing score quartiles were strongly related to the occurrence of hard cardiac events including myocardial infarction and death (p < 0.001) and all cardiovascular events (p < 0.001). Stratification by age- and gender-matching further increased the prognostic ability of EBT (for scores above vs. below the age- and gender-matched CAC scores; odds ratio: 13.1, 95% confidence intervals: 5.62, 35.9).
Conclusions:
These data support previous reports demonstrating that the presence of CAC in a symptomatic cohort is a strong predictor of future cardiac events. This study supports the use of EBT in a symptomatic cohort with prompt discharge of those patients with negative scans. Furthermore, the absence of CAC is associated with a very low risk of future cardiac risk events in this population over the subsequent seven years (annual event rate <1%).
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