Cardiac CTA Beneficial for Low-Risk, Acute Chest Pain Triage
Findings from an imaging investigation of patients with low-risk acute chest pain were recently presented at the Transcatheter Cardiovascular Therapeutics (TCT). Details from the presentation were described by Health Imaging News . The study was previously published in the February issue of the Journal of the American College of Cardiology. The team, from William Beaumont Hospital in Michigan, evaluated over 200 patients with low risk factors for cardiac disease. Patients had normal enzymes and ECG and were immediately sent for Cardiac CT Angiography (CCTA). Disposition of patients was determined within three quarters of the patients based on findings from the CCTA. The remaining patients required additional evaluation with stress imaging.
Hospitalization was reduced significantly among the cohort members. Study patients were seen over 3.6 hours compared to 16.5 hours. The modified diagnostic protocol, employing CCTA, also reduced overall costs by 15 percent.
Annually, over six million patients present with acute chest pain. Costs for associated treatment range between $10 and $12 billion. CCTA appears, based on the data described, to be an ideal method to evaluate patients for the presence of acute coronary artery disease. This imaging modality can rule out aortic dissection and pulmonary embolism and verify the presence of coronary artery disease.
Importantly, this technique has a negative predictive value of less than 90 percent. Additionally, CCTA can provide a rapid diagnosis, which makes it a cost-effective imaging modality. Another reason this approach is appropriate is because it can reduce the amount of pain for patients, as well shorten hospitalization.
The researchers compared CCTA to echocardiography, which is not able to rule out ischemia. An additional problem presents for patients who have pain that resolves during triage. Other techniques commonly employed to rule out cardiac disease are also fraught with problems, including ETT, pragmatics, ECG, and enzyme tests.
One limitation is that CCTA may not be the best approach for the whole population, but rather reserved for those with middle aged persons who are generally healthy. Other researchers at the conference suggested that scoring of coronary calcium may be superior for asymptomatic patients.
October 24, 2007 Related topics: Imaging, Diagnostic, Emergency, Cardiology