Cardiac CT angiography in the emergency department
Maya Galperin-Aizenberg1, Tessa S Cook, Judd E Hollander
11 Department of Radiology, University of Pennsylvania Medical Center, 3400 Spruce St, 1 Silverstein, Philadelphia, PA 19104.
Insights
Cardiac CT angiography (CTA) helps emergency departments quickly identify low-risk acute coronary syndrome (ACS) patients with chest pain. This safe and efficient imaging tool enables expedited discharge, reducing hospital admissions.
Area of Science:
- Cardiology
- Emergency Medicine
- Radiology
Background:
- Annually, nearly 8 million patients visit US emergency departments with acute chest pain.
- Accurate risk stratification for acute coronary syndrome (ACS) is challenging.
- Early diagnostic imaging is crucial for managing chest pain patients.
Purpose of the Study:
- To discuss the role of cardiac CT angiography (CTA) in evaluating emergency department patients with chest pain.
- To review the technology, protocols, benefits, and limitations of cardiac CTA based on 10 years of institutional experience.
- To assess cardiac CTA as a safe, efficient, and cost-effective risk stratification tool.
Main Methods:
- Review of institutional 10-year experience with cardiac CTA in the emergency department setting.
- Analysis of cardiac CTA technology and protocols for chest pain evaluation.
- Assessment of patient outcomes, including risk of adverse events and length of stay.
Main Results:
- Early cardiac CTA identifies a low-risk patient group (<1% 30-day adverse events).
- Cardiac CTA facilitates safe and expedited patient discharge from the emergency department.
- A strategy utilizing early cardiac CTA demonstrates efficiency by preventing unnecessary admissions.
Conclusions:
- Early cardiac CTA is a valuable tool for risk stratification in emergency department patients with chest pain.
- This imaging modality enables rapid identification of low-risk individuals, allowing for safe discharge.
- Potential overutilization and long-term implications require further investigation.
Abstract:
OBJECTIVE. Nearly 8 million patients present annually to emergency departments (EDs) in the United States with acute chest pain. Identifying those with a sufficiently low risk of acute coronary syndrome (ACS) remains challenging. Early imaging is important for risk stratification of these individuals. The objective of this article is to discuss the role of cardiac CT angiography (CTA) as a safe, efficient, and cost-effective tool in this setting and review state-of-the-art technology, protocols, advantages, and limitations from the perspective of our institution's 10-year experience. CONCLUSION. Early utilization of cardiac CTA in patients presenting to the ED with chest pain and a low to intermediate risk of ACS quickly identifies a group of particularly low-risk patients (< 1% risk of adverse events within 30 days) and allows safe and expedited discharge. By preventing unnecessary admissions and prolonged lengths of stay, a strategy based on early cardiac CTA has been shown to be efficient, although potential overutilization and other issues require long-term study.
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