TY - JOUR
T1 - Safety and efficiency of outpatient versus emergency department-based coronary CT angiography for evaluation of patients with potential ischemic chest pain
AU - Scheuermeyer, Frank X.
AU - Grunau, Brian
AU - Raju, Rekha
AU - Choy, Stephen
AU - Naoum, Christopher
AU - Blanke, Philipp
AU - Hague, Cameron
AU - Heilbron, Brett
AU - Taylor, Carolyn
AU - Kalla, Daniel
AU - Christenson, Jim
AU - Innes, Grant
AU - Hanakova, Michaela
AU - Leipsic, Jonathon
PY - 2015/11/1
Y1 - 2015/11/1
N2 - Background: While coronary CT angiography (coronary CTA) may be comparable to standard care in diagnosing acute coronary syndrome (ACS) in emergency department (ED) chest pain patients, it has traditionally been obtained prior to ED discharge and a strategy of delayed outpatient coronary CTA following an ED visit has not been evaluated. Objective: To investigate the safety of discharging stable ED patients and obtaining outpatient CCTA. Methods: At two urban Canadian EDs, patients up to 65 years with chest pain but no findings indicating presence of ACS were further evaluated depending upon time of presentation: (1) ED-based coronary CTA during normal working hours, (2) or outpatient coronary CTA within 72 hours at other times. All data were collected prospectively. The primary outcome was the proportion of patients who had an outpatient coronary CTA ordered and had a predefined major adverse cardiac event (MACE) between ED discharge and outpatient CT; secondary outcome was the ED length of stay in both groups. Results: From July 1, 2012 to June 30, 2014, we enrolled 521 consecutive patients: 350 with outpatient CT and 171 with ED-based CT. Demographics and risk factors were similar in both cohorts. No outpatient CT patients had a MACE prior to coronary CTA. (0.0%, 95% CI 0 to 0.9%) The median length of stay for ED-based evaluation was 6.6 hours (interquartile range 5.4 to 8.3 hours) while the outpatient group had a median length of stay of 7.0 hours (IQR 6.0 to 9.8 hours, n.s.). Conclusions: In ED chest pain patients with a low risk of ACS, performing coronary CTA as an outpatient may be a safe strategy.
AB - Background: While coronary CT angiography (coronary CTA) may be comparable to standard care in diagnosing acute coronary syndrome (ACS) in emergency department (ED) chest pain patients, it has traditionally been obtained prior to ED discharge and a strategy of delayed outpatient coronary CTA following an ED visit has not been evaluated. Objective: To investigate the safety of discharging stable ED patients and obtaining outpatient CCTA. Methods: At two urban Canadian EDs, patients up to 65 years with chest pain but no findings indicating presence of ACS were further evaluated depending upon time of presentation: (1) ED-based coronary CTA during normal working hours, (2) or outpatient coronary CTA within 72 hours at other times. All data were collected prospectively. The primary outcome was the proportion of patients who had an outpatient coronary CTA ordered and had a predefined major adverse cardiac event (MACE) between ED discharge and outpatient CT; secondary outcome was the ED length of stay in both groups. Results: From July 1, 2012 to June 30, 2014, we enrolled 521 consecutive patients: 350 with outpatient CT and 171 with ED-based CT. Demographics and risk factors were similar in both cohorts. No outpatient CT patients had a MACE prior to coronary CTA. (0.0%, 95% CI 0 to 0.9%) The median length of stay for ED-based evaluation was 6.6 hours (interquartile range 5.4 to 8.3 hours) while the outpatient group had a median length of stay of 7.0 hours (IQR 6.0 to 9.8 hours, n.s.). Conclusions: In ED chest pain patients with a low risk of ACS, performing coronary CTA as an outpatient may be a safe strategy.
KW - Coronary CT angiography
KW - Ischemic chest pain
UR - http://www.scopus.com/inward/record.url?scp=84949317921&partnerID=8YFLogxK
U2 - 10.1016/j.jcct.2015.08.001
DO - 10.1016/j.jcct.2015.08.001
M3 - Article
C2 - 26310589
AN - SCOPUS:84949317921
SN - 1934-5925
VL - 9
SP - 534
EP - 537
JO - Journal of Cardiovascular Computed Tomography
JF - Journal of Cardiovascular Computed Tomography
IS - 6
ER -