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The Role of Triple Rule-out CT in an Indian Emergency Setting
Navaneeth Pattereth1, Shafneed Chaliyadan2, Roshan Mathew1
1Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India.
Insights
Triple rule-out CT angiography effectively identifies significant coronary artery disease in emergency patients with acute chest pain. This diagnostic tool aids physicians in managing intermediate-risk cases and avoiding unnecessary testing.
Area of Science:
- Cardiology
- Emergency Medicine
- Radiology
Background:
- Acute non-traumatic chest pain presents a diagnostic challenge in emergency settings, balancing the risk of missing fatal diagnoses against over-testing.
- Triple rule-out computed tomography (TRO-CT) angiography is underutilized due to perceived limitations in efficacy and safety.
Purpose of the Study:
- To evaluate the diagnostic yield of TRO-CT angiography in an Indian emergency department for patients with acute chest pain.
- To enhance understanding and application of TRO-CT among emergency physicians.
Main Methods:
- Twenty-six patients with acute chest pain, non-specific ECG, and negative troponin I underwent TRO-CT.
- HEART scores were calculated and correlated with TRO-CT findings.
Main Results:
- TRO-CT angiography was positive in 20% of patients, identifying significant coronary artery disease (CAD) in 16% and acute pulmonary embolism in one.
- All patients with significant CAD detected by TRO-CT had intermediate HEART scores.
- The mean effective radiation dose was 19.024 ± 3.319 mSv.
Conclusions:
- TRO-CT angiography is a valuable tool for evaluating acute chest pain in emergency settings.
- It aids in ruling out significant CAD in intermediate-risk patients, supporting clinical decision-making.
Background:
Emergency physicians are acutely aware of the consequences of missing fatal diagnoses for acute non-traumatic chest pain and subjecting patients to over-testing. In the large arsenal of tests that are available to us, a triple rule-out computed tomography (TRO-CT) Angiography is often less pursued, due to concerns about their efficacy and safety or because of nescience. We aim to find the yield of the test in an Indian emergency setting and impart some knowledge about it along the way.
Materials And Methods:
Twenty-six patients who presented to the emergency department of our institute with acute chest pain, with non-specific electrocardiogram (ECG) findings and negative serial troponin I, underwent TRO-CT. HEART scores of all patients, calculated at their presentation, were correlated with TRO-CT findings.
Results:
Triple rule-out computed tomography angiography was positive in 5 patients (20%), of which 4 cases (16%) were diagnosed to have significant coronary artery disease and one had an acute pulmonary embolism. All 4 patients who had significant coronary artery disease (CAD) diagnosed by TRO-CT had a HEART score of intermediate risk. The mean effective radiation dose of the entire TRO study was 19.024 ± 3.319 mSv (range = 13.89-25.95 mSv).
Conclusion:
Triple rule-out CT angiography is a useful tool in the evaluation of patients presenting with acute chest pain in the emergency and can be an important adjunct in ruling out significant CAD in intermediate-risk patients. Emergency physicians and young residents need to know about this tool in their armamentarium to tackle doubtful cases.
How To Cite This Article:
Pattereth N, Chaliyadan S, Mathew R, Kumar S, Das CJ, Aggarwal P. et al. The Role of Triple Rule-out CT in an Indian Emergency Setting. Indian J Crit Care Med 2023;27(3):190-194.
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