CT Angiography for Safe Discharge of Patients with Possible Acute Coronary Syndromes

• Published in: The New England journal of medicine Vol. 366; no. 15; pp. 1393 - 1403
• Main Authors: Litt, Harold I, Gatsonis, Constantine, Snyder, Brad, Singh, Harjit, Miller, Chadwick D, Entrikin, Daniel W, Leaming, James M, Gavin, Laurence J, Pacella, Charissa B, Hollander, Judd E
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 12.04.2012
• Subjects: Acute Coronary Syndrome - diagnostic imaging; Acute Coronary Syndrome - mortality; Acute coronary syndromes; Adult; Aged; Angina pectoris; Angiography; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular disease; Cardiovascular system; Computed tomography; Confidence Intervals; Coronary Angiography - methods; Coronary Disease - diagnosis; Coronary Disease - diagnostic imaging; Coronary Disease - therapy; Coronary heart disease; Coronary vessels; Female; General aspects; Health Resources - utilization; Heart; Heart attacks; Hospitalization; Humans; Investigative techniques, diagnostic techniques (general aspects); Length of Stay; Male; Medical sciences; Middle Aged; Myocardial infarction; Myocardial Infarction - epidemiology; Patient Discharge; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Thrombolysis; Tomography, X-Ray Computed; United States > US; Pennsylvania; Human; Angiography; Radiodiagnosis; Cardiovascular disease; Patient; Coronary heart disease; Myocardial disease; Discharge; Medicine; Medical imagery; Computerized axial tomography; Angiocomputed tomography; Acute coronary syndrome
• ISSN: 0028-4793; 1533-4406; 1533-4406
• DOI: 10.1056/NEJMoa1201163

Patients with chest pain have a high hospital admission rate, but often no cardiac cause is found. In this trial, coronary CT angiography accurately identified patients who were free from coronary disease and could be safely discharged from the emergency department. Patients who present to the emergency department with signs and symptoms consistent with a possible acute coronary syndrome pose a diagnostic dilemma. 1 – 6 Despite the introduction of clinical decision rules 6 – 15 and the improved sensitivity of cardiac markers, 15 – 17 most patients are admitted to the hospital so that an acute coronary syndrome can be ruled out, even though for most of these patients, the symptoms are ultimately found not to have a cardiac cause. The absence of evidence of coronary disease on invasive coronary angiography is associated with a low risk of future cardiac events. 18 , 19 Coronary computed tomographic angiography . . .