Marlene Busko

July 27, 2015

LAS VEGAS, NV — Low- to intermediate-risk patients who arrived at a hospital emergency department with chest pain and had a coronary CT angiography (CCTA) scan were discharged in about 8 hours if the scan failed to detect significant CAD; otherwise they were discharged after about 3 days, in a single-center study[1].

Dr Nandini M Meyersohn (Massachusetts General Hospital, Boston) explained that the emergency department of their tertiary-care center has a CT scanner. "We found that people who didn't have significant CAD [defined as >50% stenosis] were out in an average of 8 hours [or at most, in about 24 hours], which is much faster than the standard of care, and this is a real-world setting," she told heartwire from Medscape. She presented the findings here during a poster session at the Society of Cardiovascular Computed Tomography (SCCT) 2015 Annual Scientific Meeting.

The patients were all-comers, that is, the cohort comprised all low- to intermediate-risk patients with acute chest pain who were candidates for CCTA—including those with unusual heart rhythms or a large body-mass index, who are typically excluded from clinical trials, Meyersohn pointed out.

The study reinforces the value of CCTA to rule out CAD and adds information about potential discharge times, according to poster-session comoderator Dr Gilbert L Raff (William Beaumont Hospital, Royal Oak, MI). It showed that "CT is effective in patients who don't have disease, and it gets them home more quickly," he said. "That's the strength of this technique—you really can differentiate a lot of people who don't need medical care."

Discharge Times in Patients With or Without Major CAD

Randomized controlled trials have established that CCTA is useful to evaluate low-risk patients who present to the emergency department with acute chest pain, and it may rule out disease and lead to faster discharge in patients without newly discovered significant coronary artery stenosis, write Meyersohn and colleagues.

They aimed to evaluate the relationship between coronary artery stenosis severity and time to discharge in patients presenting to their emergency department with suspected MI.

Researchers identified 684 patients with acute chest pain who were seen in their emergency department and referred for CCTA between October 2012 and March 2015.

CCTA revealed that 569 patients (83%) had no significant CAD, but the remaining 115 patients (17%) had at least moderate coronary artery stenosis (>50% stenosis).

From triage to hospital discharge took about 8.6 hours for patients without significant CAD. The median time spent in the hospital before discharge increased stepwise with increasing coronary artery stenosis—from 8 hours to 28.4 hours to 64.1 hours in patients with mild, moderate, or severe stenosis, respectively.

Severity of Coronary Artery Stenosis and Time to Discharge from ER

Stenosis severity Patients, n Median time to discharge, h (IQR)
None 347 7.0 (4.9–19.5)
Mild 222 8.6 (6.3–20.0)
None or mild 569 7.9 (5.3–19.6)
Moderate 53 28.4 (25.1–37.6)
Severe/occluded 62 64.1 (40.4–96.3)
Moderate or severe/occluded 115 43.1 (26.2–77.2)
Mild: >0% to <50% stenosis
Moderate: 50% to 70% stenosis
Severe/occluded: >70% stenosis
IQR: interquartile range

Cost-effectiveness analysis of CCTA in low- to intermediate-risk patients with chest pain should divide these patients into two groups—those with and without CCTA-detected significant CAD—Meyersohn and colleagues suggest, as there is a clear distinction in time to discharge from the hospital because of different treatment trajectories.

The researchers are continuing to study the patient population and, to date, have CCTA data from about 1000 patients, Meyersohn said.

Meyersohn reported no relevant financial relationships.

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