Combined stress myocardial CT perfusion and coronary CT angiography as a feasible strategy among patients presenting with acute chest pain to the emergency department

2020 ◽  
Author(s):  
Gowtham R. Grandhi ◽  
Juan C. Batlle ◽  
Christopher D. Maroules ◽  
Warren Janowitz ◽  
Constantino S. Peña ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Ct Angiography ◽  
Coronary Ct Angiography ◽  
Ct Perfusion ◽  
Acute Chest Pain ◽  
Combined Stress ◽  
Coronary Ct ◽  
Myocardial Ct Perfusion

Abstract 46: Potential of Coronary CT Angiography to Optimize Medical Therapy in Patients Presenting With Acute Chest Pain

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Amit Pursnani ◽  
Christopher L Schlett ◽  
Pearl Zakroysky ◽  
Parmanand Singh ◽  
James L Januzzi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Secondary Prevention ◽  
Ct Angiography ◽  
Medical Therapy ◽  
Coronary Ct Angiography ◽  
Acute Chest Pain ◽  
Coronary Ct ◽  
Prevention Guidelines ◽  
Pain Patients

Background: Coronary artery disease (CAD) detected by coronary CT angiography (CCTA) independently predicts cardiovascular events. We assessed the potential of CCTA to tailor aspirin (ASA) and statin medical therapy in acute chest pain patients presenting to the emergency department. Methods: We included all patients from the Rule Out Myocardial Infarction Using Computer Assisted Tomography (ROMICAT) Trial. This prospective double-blinded observational cohort study included patients presenting with chest pain to the emergency department with low-intermediate risk for acute coronary syndrome (ACS). Patients underwent CCTA prior to admission, followed by standard evaluation. Caretakers were blinded to CCTA results. We assessed medical therapy at presentation and discharge, and determined concordance of CAD status by CCTA with medical therapy dictated by standard care. Results: Complete data on medical therapy was available in 358/368 patients (99%), (53±12 years, 61% men) of whom 7 had a contraindication to ASA and 11 to statin. Standard of care included stress testing in 71% of patients. Prescription of ASA and statins increased from admission to discharge (See Figure). At discharge, 33% of patients without CAD were on ASA and 14% were on statin. Conversely, 46% of patients with nonobstructive CAD by CCTA did not receive ASA and 59% did not receive statin at discharge. Only 66% of patients with obstructive CAD were on statin and ASA at discharge. Based on 2011 American College of Cardiology/American Heart Association secondary prevention guidelines, there was discordance between CAD status by CCTA and medical therapy in 51% of patients. Conclusions: CCTA has great potential to optimize adherence to secondary prevention guidelines in chest pain patients presenting to the emergency department.

Coronary CT angiography for acute chest pain in the emergency department

2014 ◽  
Vol 8 (5) ◽  
pp. 359-367 ◽  
Author(s):  
Henrique Lane Staniak ◽  
Marcio Sommer Bittencourt ◽  
Christopher Pickett ◽  
Michael Cahill ◽  
David Kassop ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Ct Angiography ◽  
Coronary Ct Angiography ◽  
Acute Chest Pain ◽  
Coronary Ct

Coronary CT Angiography in Acute Chest Pain

2016 ◽  
Author(s):  
Christoph I. Lee
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Ct Angiography ◽  
Coronary Ct Angiography ◽  
Acute Chest Pain ◽  
Diagnostic Efficiency ◽  
Additional Information ◽  
Coronary Ct ◽  
Lengths Of Stay ◽  
Coronary Syndromes

This chapter, found in the chest pain section of the book, provides a succinct synopsis of a key study examining the use of computed tomography (CT) angiography for triaging patients with acute chest pain. This summary outlines the study methodology and design, major results, limitations and criticisms, related studies and additional information, and clinical implications. The study showed that for patients presenting to the emergency department with symptoms suggesting acute coronary syndromes, incorporating early coronary CT angiography into the triage strategy improves diagnostic efficiency, with more direct discharges from the emergency department and shorter lengths of stay for those admitted. In addition to outlining the most salient features of the study, a clinical vignette and imaging example are included in order to provide relevant clinical context.

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