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Long-term outcome after CT angiography in patients with possible acute coronary syndrome
Arthur Nasis1, Ian T Meredith, Priyanka S Sud
1From the Monash Cardiovascular Research Centre, MonashHEART, Monash Health and Monash University Department of Medicine (MMC), 246 Clayton Rd, Clayton 3168, Australia (A.N., I.T.M., P.S.S., J.D.C., J.M.T., S.K.S.); Department of Diagnostic Imaging, Monash Health, Melbourne, Australia (J.M.T.); and Department of Medical Imaging & Radiation Sciences, Faculty of Medicine, Nursing & Radiation Sciences, Monash University, Melbourne, Australia (J.M.T.).
Insights
Computed tomographic (CT) angiography is a safe strategy for evaluating patients with chest pain and low to intermediate risk of acute coronary syndrome (ACS). Long-term follow-up shows low readmission rates and no deaths or revascularizations in discharged patients.
Area of Science:
- Cardiology
- Radiology
- Emergency Medicine
Background:
- Acute coronary syndrome (ACS) is a common emergency department presentation.
- Accurate risk stratification is crucial for timely and appropriate management.
- Computed tomographic (CT) angiography offers a non-invasive imaging modality for coronary artery assessment.
Purpose of the Study:
- To evaluate the long-term outcomes and hospital readmission rates.
- To assess the safety and efficacy of a CT angiography-guided strategy.
- To manage patients presenting with symptoms suggestive of ACS.
Main Methods:
- Prospective evaluation of 585 patients with low to intermediate ACS risk.
- Coronary CT angiography performed after troponin I measurement.
- Management decisions based on CT angiography findings: discharge, outpatient referral, or admission.
Main Results:
- 34% had no plaque, 49% nonobstructive plaque, 4% moderate stenosis, 13% severe stenosis.
- Median follow-up of 47.4 months for 506 discharged patients.
- 1% readmission for chest pain; 0% for ACS, death, or revascularization.
Conclusions:
- CT angiography-guided strategy is safe for low to intermediate risk ACS patients.
- Effective for patients discharged after single troponin I measurement.
- Demonstrates favorable long-term outcomes and low readmission rates.
Purpose:
To assess the long-term outcome and hospital readmission rate associated with a computed tomographic (CT) angiography-guided strategy used to examine patients who present to the emergency department (ED) with symptoms of possible acute coronary syndrome (ACS).
Materials And Methods:
The study was approved by the institutional review board, and all patients provided written informed consent. A total of 585 consecutive patients (mean age, 58 years ± 11 [standard deviation]; 58% were male) with ischemic-type chest pain and low to intermediate risk for ACS were evaluated prospectively. Patients underwent coronary CT angiography after single or serial troponin I (TnI) measurement, depending on time of presentation to the ED. Subsequent care was determined with CT angiography findings: Patients without plaque and patients with nonobstructive plaque and at most mild to moderate stenosis (<40% luminal narrowing) were discharged without further investigation. Patients with moderate stenosis (40%-70% narrowing) were discharged and referred for outpatient stress echocardiography. Patients with severe stenosis (>70% narrowing) were admitted. Discharged patients were contacted and their medical records were reviewed to determine rates of death, ACS, revascularization, and hospital admission. By using binomial distribution, Clopper-Pearson confidence intervals (CIs) were calculated for outcome data.
Results:
Coronary CT angiography findings were as follows: A total of 196 patients (34%) had no coronary plaque or stenosis, 288 (49%) had nonobstructive plaque, 22 (4%) had moderate stenosis, and 79 (13%) had severe stenosis. At median 47.4-month follow-up (range, 24-57 months) of the 506 discharged patients, five (1%; 95% CI: 0.4%, 2.3%) had been readmitted for chest pain; there were no instances of coronary revascularization, ACS, or death (0% for all; 95% CI: 0%, 0.7%). Follow-up was 100% complete.
Conclusion:
Use of a CT angiography-guided strategy to investigate patients with low to intermediate risk of ACS who present to the ED with chest pain is safe at long-term follow-up, including patients discharged after single TnI measurement.
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