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The early after discharge cardiac CT for low-risk chest pain study: the ED-CT study
Michael Cronin1, Aisling Gill1, Eve Blake1
1Department of Cardiology, St James Hospital, Dublin D08 NHY1, Republic of Ireland.
Insights
An accelerated diagnostic pathway using outpatient cardiac CT angiography for chest pain patients showed no mortality or myocardial infarction. This approach led to minimal downstream testing and revascularization, improving patient outcomes.
Area of Science:
- Cardiology
- Radiology
- Emergency Medicine
Background:
- Chest pain is a common emergency department presentation.
- Risk stratification is crucial for managing chest pain patients.
- Accelerated diagnostic pathways aim to improve efficiency and patient outcomes.
Purpose of the Study:
- To evaluate an accelerated diagnostic pathway for low-risk chest pain patients.
- To compare outcomes of early outpatient cardiac CT angiography versus inpatient invasive angiography.
- To identify factors influencing physician decision-making in chest pain management.
Main Methods:
- A 30-day cohort study compared patients undergoing early outpatient CT angiography with those receiving inpatient invasive angiography.
- Data collected included patient outcomes and factors influencing diagnostic test selection.
- The study analyzed differences between the two patient groups.
Main Results:
- 369 patients underwent CT, and 37 underwent angiography.
- No mortality or myocardial infarction occurred at 30 days.
- Calcium score significantly influenced decisions on statin therapy, angiography, and revascularization (OR 59, P < .001).
Conclusions:
- An accelerated pathway using outpatient cardiac CT for chest pain is safe and effective.
- This pathway resulted in no major adverse cardiac events.
- It led to a low rate of downstream invasive procedures and revascularization.
Objectives:
An accelerated diagnostic pathway is created to aid the management of low-risk patients presenting to the emergency room with chest pain. Records are taken of patient outcomes and factors influencing physician decision-making between inpatient invasive angiography versus early outpatient cardiac CT angiography.
Methods:
A cohort study at 30 days post discharge is undertaken over 1 year. Differences are observed between a population of patients who underwent early outpatient CT and a population of ambulatory haemodynamically stable patients who underwent inpatient fluoroscopic angiography.
Results:
Totally, 369 patients underwent CT (F = 46%) and 37 underwent angiography (F = 30%). Median outpatient CT was at 14 days. At 30 days, 0 patients suffered mortality or myocardial infarction. Eleven percent were recommended for invasive angiography. Two percent of CT patients underwent coronary revascularization. Median calcium score was 0. Twenty percent of the CT population were commenced on high-potency statin or had their pre-existing statin dose intensified. Calcium score affected a composition of statin commencement, angiography, and revascularization (OR 59, P < .001). Age, troponin, vascular disease, and previous coronary revascularization appeared to influence choice between coronary computed tomography angiography (CCTA) and invasive angiography.
Conclusion:
An accelerated diagnostic pathway for outpatient cardiac CT for chest pain resulted in no mortality or myocardial infarction, with a low level of downstream testing and coronary revascularization.
Advances In Knowledge:
At a median time to CCTA of 14 days post discharge from the emergency department, there is no effect on patient major adverse cardiac events.
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