CT angiography cuts unnecessary hospitalization of ER patients

Using CT angiography to diagnose lower-risk emergency department patients with chest pain cuts down on hospitalization of those who don’t need it, according to a study published in the September issue of Radiology.

Arthur Nasis, MBBS, MD, FRACP, of Monash University’s Department of Medicine, in Melbourne, Australia, and colleagues said they found that using a CT angiography–guided algorithm resulted in direct ED discharge of 86 percent of all patients who had symptoms of possible acute coronary syndrome (ACS).

The authors, citing previous research, noted that some 85 percent of patients who go to an ED with chest pain have symptoms that are not caused by ACS. Yet, because their symptoms mimic possible ACS, they may end up hospitalized, placing a burden on the health system.

Increasingly, to prevent these unnecessary hospitalizations, CT angiography is being used to diagnose lower risk patients who come to the ED with chest pain, the authors noted.

The prospective, observational study, which ran from September 2008 through May 2011, followed 585 consecutive patients with chest pain who went to the ED of the Monash Medical Centre.

Patients were chosen for the study only if they met certain criteria, including: ischemic-type chest pain, (assessed by an ED clinician and cardiologist), a low to intermediate risk for ACS, negative findings in Tnl measurement, and no ST segment deviation on an electrocardiogram. All of the patients were at low to intermediate risk for ACS.

 The patients were evaluated in accordance with one of two predefined CT angiography–guided algorithms, depending on whether they were at the ER during CT angiography operational hours, from 7:00 am to 4:00 p.m.

Only one percent of the patients in the study returned to the ED during the follow-up period, and only two percent were readmitted to the hospital. There were no cases of ACS or death at the median 4-year follow-up, the authors said.

 “In this large prospective observational study of patients with low- to intermediate-risk ischemic-type chest pain with possible ACS, we found that the upper limit of the CI for the rate of death, ACS, or revascularization was less than 1 percent a median of 47.4 months after initial ED presentation,” the authors wrote.

While other studies have looked at the advantages of using CT angiography to diagnose lower risk ED patients with chest pain, this study is believed to be the first long-term study, they said.