Routine coronary computed tomographic angiography reduces unnecessary hospital admissions, length of stay, recidivism rates, and invasive coronary angiography in the Emergency Department triage of chest pain.
J Am Coll Cardiol. 2013 May 15;
Authors: Poon M, Cortegiano M, Abramowicz AJ, Hines M, Singer AJ, Henry MC, Viccellio P, Hellinger JC, Ferraro S, Poon A, Raff GL, Voros S, Farkouh ME, Noack P
Abstract
OBJECTIVES: Assess the effects on resource utilization of routine coronary computed tomographic angiography (CCTA) in triaging chest pain patients in the Emergency Department (ED). BACKGROUND: The routine use of CCTA for ED evaluation of chest pain is feasible and safe. METHODS: We conducted a retrospective multivariate analysis of 894 risk-matched cohorts of ED patients presenting with chest pain to assess the impact of CCTA vs. standard evaluation on admissions rate, length of stay, major adverse cardiovascular event rates, recidivism rates, and downstream resource utilization. RESULTS: The overall admission rate was lower for CCTA (14% vs. 40%, p<0.001). Standard evaluation was 5.5 times more likely to be admitted (OR = 5.53, P<0.001). Expected ED length of stay for standard evaluation was about 1.6 times longer (OR = 1.55, p<0.001). There was no difference in the rates of deaths and acute myocardial infarction within 30 days of the index visit in either group. The odds of returning to the ED within 30 days for recurrent chest pain were 5 times greater for standard evaluation (OR = 5.06, p=0.022). Standard evaluation was 7 times more likely to undergo invasive coronary angiography without revascularization (OR = 7.17, p≤ 0.001), while neither group was significantly more likely to receive revascularization (OR = 2.06, p=0.193). The median radiation dose for CCTA was 5.88 (n = 1039, C.I. 5.2 to 6.4) mSv. CONCLUSIONS: Routine use of CCTA in ED evaluation of chest pain reduces healthcare resource utilization.
PMID: 23684682 [PubMed - as supplied by publisher]