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Secondary cardiac risk stratifying tests after coronary computed tomography angiography in emergency department

Vincent A Verheij1, Jan-Erik Scholtz2, Nandini M Meyersohn2

  • 1Department of Emergency Medicine, Massachusetts General Hospital & Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.

Journal of Cardiovascular Computed Tomography
|October 21, 2018
PubMed

Insights

Secondary cardiac risk stratifying tests after coronary computed tomography angiography (CTA) in the emergency department are low, particularly for negative CTA results. Structured post-CTA guidelines are essential for appropriate patient management.

Area of Science:

  • Cardiology
  • Radiology
  • Emergency Medicine

Background:

  • Coronary computed tomography angiography (CTA) in triage strategies has shown increased secondary cardiac risk stratifying tests (SCRSTs).
  • The impact of CTA on SCRSTs in routine emergency department (ED) clinical care is not well-established.
  • This study investigates SCRST rates following the implementation of coronary CTA in an ED setting.

Purpose of the Study:

  • To evaluate the rates of secondary cardiac risk stratifying tests (SCRSTs) after coronary CTA in routine clinical practice.
  • To determine if SCRST rates vary based on coronary CTA results (positive, intermediate, negative, non-diagnostic).
  • To assess adherence to local management recommendations for post-CTA diagnostic strategies.

Main Methods:

  • A single-site retrospective cohort study of ED patients who received coronary CTA between October 1, 2012, and September 30, 2016.
  • SCRSTs included functional cardiac tests and invasive coronary angiography (ICA).
  • Data analysis focused on CTA results and the performance of subsequent SCRSTs.

Main Results:

  • Out of 1916 patients, 9.3% had positive, 5.5% intermediate, 84.1% negative, and 1.1% non-diagnostic CTAs.
  • Overall SCRST rate was 12.4% (5.6% noninvasive, 6.7% ICA).
  • SCRST rates were high after positive (73.7%) and intermediate (72.4%) CTAs, but low after negative (1.1%) and non-diagnostic (47.6%) CTAs.

Conclusions:

  • Routine emergency department coronary CTA is associated with low rates of secondary cardiac risk stratifying tests, especially in patients with negative CTA findings.
  • Structured management guidelines for post-coronary CTA care are crucial.
  • High adherence (96.2%) to local management recommendations was observed.
Abstract

Keywords:
Acute chest painAcute coronary syndromeCoronary CTADownstream testingSecondary cardiac risk stratifying tests

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