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Title: | Long-term outcome after CT angiography in patients with possible acute coronary syndrome. | Authors: | Meredith I.T. ;Nasis A. ;Sud P.S.;Seneviratne S.K.;Troupis J.M.;Cameron J.D. | Institution: | (Nasis, Meredith, Sud, Cameron, Troupis, Seneviratne) Monash Cardiovascular Research Centre, Monash University, Department of Medicine (MMC), 246 Clayton Rd, Clayton, VIC 3168, Australia (Troupis) Department of Diagnostic Imaging, Monash Health, Melbourne, VIC, Australia (Troupis) Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing and Radiation Sciences, Monash University, Melbourne, VIC, Australia | Issue Date: | 11-Sep-2014 | Copyright year: | 2014 | Publication information: | Radiology. 272 (3) (pp 674-682), 2014. Date of Publication: September 2014. | Abstract: | Purpose: To assess the long-term outcome and hospital readmission rate associated with a computed tomographic (CT) angiography-guided strategy used to examine patients who present to the emergency department (ED) with symptoms of possible acute coronary syndrome (ACS). Material(s) and Method(s): The study was approved by the institutional review board, and all patients provided written informed consent. A total of 585 consecutive patients (mean age, 58 years +/- 11 [standard deviation]; 58% were male) with ischemictype chest pain and low to intermediate risk for ACS were evaluated prospectively. Patients underwent coronary CT angiography after single or serial troponin I (TnI) measurement, depending on time of presentation to the ED. Subsequent care was determined with CT angiography findings: Patients without plaque and patients with nonobstructive plaque and at most mild to moderate stenosis (<40% luminal narrowing) were discharged without further investigation. Patients with moderate stenosis (40%-70% narrowing) were discharged and referred for outpatient stress echocardiography. Patients with severe stenosis (>70% narrowing) were admitted. Discharged patients were contacted and their medical records were reviewed to determine rates of death, ACS, revascularization, and hospital admission. By using binomial distribution, Clopper-Pearson confidence intervals (CIs) were calculated for outcome data. Result(s): Coronary CT angiography findings were as follows: A total of 196 patients (34%) had no coronary plaque or stenosis, 288 (49%) had nonobstructive plaque, 22 (4%) had moderate stenosis, and 79 (13%) had severe stenosis. At median 47.4-month follow-up (range, 24-57 months) of the 506 discharged patients, five (1%; 95% CI: 0.4%, 2.3%) had been readmitted for chest pain; there were no instances of coronary revascularization, ACS, or death (0% for all; 95% CI: 0%, 0.7%). Follow-up was 100% complete. Conclusion(s): Use of a CT angiography-guided strategy to investigate patients with low to intermediate risk of ACS who present to the ED with chest pain is safe at long-term follow-up, including patients discharged after single TnI measurement. © RSNA, 2014. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1148/radiol.14132680 | Link to associated publication: | Click here for full text options | PubMed URL: | 24738614 [http://www.ncbi.nlm.nih.gov/pubmed/?term=24738614] | ISSN: | 0033-8419 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/42036 | Type: | Article | Subjects: | echocardiograph emergency ward female follow up heart muscle ischemia hospital admission hospital discharge hospital readmission human informed consent institutional review male medical record review observational study outcome assessment outpatient patient care priority journal prospective study protein determination stress echocardiography symptom thorax pain two dimensional echocardiography iopromide/iv [Intravenous Drug Administration] troponin I/ec [Endogenous Compound] major clinical study *acute coronary syndrome/di [Diagnosis] *acute coronary syndrome/su [Surgery] adult *angiocardiography article atherosclerotic plaque/di [Diagnosis] cardiovascular mortality cardiovascular risk cohort analysis *computed tomographic angiography computed tomography scanner controlled study coronary artery obstruction/di [Diagnosis] coronary artery recanalization diagnostic imaging equipment disease severity controlled study coronary artery obstruction / diagnosis coronary artery recanalization diagnostic imaging equipment disease severity echocardiograph emergency ward female follow up heart muscle ischemia hospital admission hospital discharge hospital readmission human informed consent institutional review major clinical study male medical record review observational study outcome assessment outpatient patient care priority journal *angiocardiography protein determination stress echocardiography symptom thorax pain two dimensional echocardiography adult *acute coronary syndrome / *diagnosis / *surgery prospective study article atherosclerotic plaque / diagnosis cardiovascular mortality cardiovascular risk cohort analysis *computed tomographic angiography computed tomography scanner |
Type of Clinical Study or Trial: | Observational study (cohort, case-control, cross sectional or survey) |
Appears in Collections: | Articles |
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