Abstract: It is unclear whether an evaluation incorporating coronary computed tomographic angiography (CCTA) is more effective than standard evaluation in the emergency department in patients with symptoms suggestive of acute coronary syndromes.
Methods: In this single trial, we randomly assigned patients 20 to 75 years of age with symptoms suggestive of acute coronary syndromes but without ischemic electrocardiographic changes or an initial positive troponin test to early CCTA or to standard evaluation in the emergency department on Mondays and thusdays during daylight hours between(May 2014 to june 2015). The primary end point was length of stay in the hospital. Secondary end points included rates of discharge from the emergency department, major adverse cardiovascular events at 28 days, and cumulative costs. Safety end points were undetected acute coronary syndromes.
Results: The rate of acute coronary syndromes among 95 patients with a mean (±SD) age of 50.987±8 years (24.2% women), (75.8 % men).After early CCTA, as compared with standard evaluation, the mean length of stay in the hospital was reduced by 17 hours (P<0.0001) and more patients were discharged directly from the emergency department (P<0.0001). There were no undetected acute coronary syndromes and no significant differences in major adverse cardiovascular events at 28 days.
The total cumulative mean cost of care was less in the CCTA group as compared to the standard evaluation group (45000EP and71800 EP, respectively; P =<0.0001).
Conclusions: In patients in the emergency department with symptoms suggestive of acute coronary syndromes, incorporating CCTA into a triage strategy improved the efficiency of clinical decision making, as compared with a standard evaluation in the emergency department, with decrease in the overall costs of care.
Keywords: coronary computed tomographic angiography (CCTA), electrocardiographic (ECG).
Title: Coronary Computed Tomography Angiography for Early Triage of Patients with Acute Coronary Syndrome
Author: Dina A. Moghazi, Ahmed M. Kamal El Din, Saad M. Ammar, Khaled A.EL RaBbat
International Journal of Healthcare Sciences
ISSN 2348-5728 (Online)
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