Negative ECG-gated cardiac CT in patients with low-to-moderate risk chest pain in the emergency department: 1-year
William P Shuman1, Janet M May, Kelley R Branch
1Department of Radiology, University of Washington School of Medicine, Seattle, WA 98195, USA. wshuman@u.washington.edu
Insights
A negative cardiac CT angiogram (computed tomography angiogram) effectively ruled out adverse cardiac events in low-to-moderate risk chest pain patients over one year. This diagnostic imaging tool aids in safe emergency department evaluations.
Area of Science:
- Cardiology
- Radiology
- Emergency Medicine
Background:
- Chest pain is a common emergency department presentation.
- Risk stratification is crucial for managing patients with chest pain.
- Cardiac CT angiography (CCTA) is increasingly used in evaluating suspected coronary artery disease.
Purpose of the Study:
- To determine the incidence of adverse cardiac events in patients with low-to-moderate risk chest pain after a negative CCTA.
- To assess the safety and utility of CCTA in the emergency department setting for chest pain evaluation.
Main Methods:
- Seventy patients with negative CCTA results (<50% stenosis) and low-to-moderate risk chest pain were followed for 12 months.
- Follow-up included detailed interviews and electronic medical record reviews at 3, 6, and 12 months.
- Patients with positive CCTA underwent further cardiac catheterization and stent placement.
Main Results:
- No adverse cardiac events were reported by any of the 70 patients during the 12-month follow-up period.
- The etiology of chest pain remained unknown in 49 patients at one year.
- Three out of four patients with >=50% stenosis on CCTA underwent cardiac catheterization and stent placement.
Conclusions:
- A negative CCTA appears to be a safe endpoint for patients presenting with low-to-moderate risk chest pain in the emergency department.
- Adverse cardiac events are rare in the 12 months following a negative CCTA in this patient population.
- CCTA can confidently rule out significant coronary artery disease in selected emergency department patients.
Objective:
The purpose of this article is to determine the frequency of adverse cardiac events during the year following a negative cardiac CT angiogram in a population of patients presenting to the emergency department with low-to-moderate risk chest pain.
Subjects And Methods:
Eighty-one consecutive patients who had standard of care evaluation for low-to-moderate risk chest pain in the emergency department were enrolled and consented to have a cardiac CT angiogram added to their workup and to have follow-up for 1 year. Eleven patients were excluded, six because their cardiac CT examinations were unsuccessful, four because of a positive cardiac CT angiogram result, and one was lost to follow-up. Seventy patients with negative cardiac CT angiographic results (< 50% stenosis) were included and were interviewed in detail at 3, 6, and 12 months about intervening cardiac events, diagnostic testing, and therapy. Electronic medical records were also reviewed at each time point.
Results:
None of the 70 patients reported an adverse cardiac event over the 12-month follow-up period. At 1 year, the cause of chest pain was unknown in 49 patients, gastrointestinal in nine patients, anxiety in seven patients, musculoskeletal in three patients, and other in two patients. Three of four patients with 50% or greater stenosis on their cardiac CT had subsequent cardiac catheterization and stent placement.
Conclusion:
In patients with low-to-moderate risk chest pain evaluated in the emergency department, adverse cardiac events may be rare during the 12 months following a negative cardiac CT angiogram.
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