Coronary Computed Tomography Angiography Service in the Accident and Emergency Department: Pilot Study

• Published in: Hong Kong journal of radiology : HKJR = Xianggang fang she ke yi xue za zhi Vol. 25; no. 1; pp. 45 - 51
• Main Authors: Chau, HHT, Luk, WH, Ma, JKF, She, HHL, Lam, MC, Li, YK, Chan, CM, Wong, WCL
• Format: Journal Article
• Language: English
• Published: Hong Kong Hong Kong Academy of Medicine 01.03.2022
• Subjects: Acute coronary syndromes; Angioplasty; Cardiovascular disease; Clinical outcomes; Coronary vessels; Creatinine; Electrocardiography; Emergency medical care; Fatalities; Heart; Hospitals; Ischemia; Lymphoma; Medical imaging; Pain; Patients; Physicians; Risk factors; Tomography; Hong Kong China; United States > US; China
• ISSN: 2223-6619; 2307-4620
• DOI: 10.12809/hkjr2217287

Introduction Studies in western countries have shown that installation of coronary computed tomography angiography (CCTA) in the accident and emergency department (AED) facilitates safe triage and early discharge of low-to-intermediate risk patients with suspected acute coronary syndrome. The aim of this pilot study was to determine whether the workflow of a CCTA service in a local hospital AED could safely discharge low-to-intermediate risk patients presenting with acute chest pain. Methods Low-to-intermediate risk chest pain patients (stratified using the HEART score), who underwent CCTA in the AED, were included. Patient health records were followed up for 2 years. Clinical variables, time needed for diagnosis, CCTA results, and major adverse cardiac events (MACE) were evaluated. Results Thirty-four patients (17 men, 17 women) were included in this study from March to August 2017. Nineteen patients (55.9%) were low-risk and 15 (44.1%) were intermediate-risk. Mean time to CCTA was 39.2 ± 27.9 hours. Twenty-four patients (70.6%) with negative CCTA results (<50% coronary artery stenosis) were discharged home from AED and 10 patients (29.4%) with positive result (≥50% stenosis) were admitted to medical wards for further assessment. In the 2-year follow-up period, no MACE was found in the negative group. For MACE in the positive group, no cardiac death, one non-fatal myocardial infarction (contraindicated for revascularisation) and five revascularisations were noted. Conclusion CCTA allows safe discharge of low-to-intermediate risk patients presenting with acute chest pain in the AED. An AED CCTA service is effective in reducing the waiting time and length of stay.