Archives of cardiovascular diseases · 2012
Early triage of emergency department patients with acute coronary syndrome: contribution of 64-slice computed tomography angiography.
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Hascoët Sebastien, Bongard Vanina, Chabbert Valerie, Marachet Marie-Agnes, Rousseau Herve, Charpentier Sandrine, Bouisset Frederic, Honton Benjamin, Lairez Olivier, Marchal Pauline, Berry Matthieu, Carrié Didier, Galinier Michel, Elbaz Meyer
Аннотация
BACKGROUND: Multislice computed tomography coronary angiography (MSCT-CA) is feasible in the emergency department (ED) for ruling out obstructive coronary artery disease (CAD).
AIM: To investigate a diagnostic strategy using MSCT-CA for the early triage of patients presenting to the ED with acute chest pain suggestive of acute coronary syndrome (ACS), according to the medium-term incidence of clinical events.
METHODS: We conducted a single-centre, prospective, observational cohort study in 123 patients with low-risk to intermediate-risk acute chest pain suggestive of ACS. MSCT-CA was performed using dual-source 64-slice computed tomography with retrospective electrocardiographic gating. Patients without coronary artery lesions were discharged from the ED. The incidences of death, myocardial infarction and myocardial revascularization were collected during a mid-term follow-up.
RESULTS: According to MSCT-CA, 93 patients (75.6%) had no CAD or coronary artery stenosis less or equal to 50% and 28 patients (22.8%) had stenosis more or equal to 50%. Invasive coronary angiography was performed in 29 patients (23.6%). MSCT-CA accurately identified ten patients (8.13%) with obstructive CAD requiring myocardial revascularization; all had a low TIMI score (0-2) and eight had a low GRACE score. The mean estimated effective dose of MSCT-CA was 16.3±6.4 mSv. Median follow-up was 15 months. No patient (95% CI 0-3.0%) had major adverse cardiovascular events during follow-up.
CONCLUSION: MSCT-CA appears to be a useful initial triage tool in the ED. When the MSCT-CA result is negative, it allows safe early discharge because of its high negative predictive value. In a significant number of cases of low-risk ACS, MSCT-CA detects severe coronary lesions and allows further dedicated diagnostic and therapeutic intervention. Reduction of radiation exposure would help acceptance in clinical practice.
AIM: To investigate a diagnostic strategy using MSCT-CA for the early triage of patients presenting to the ED with acute chest pain suggestive of acute coronary syndrome (ACS), according to the medium-term incidence of clinical events.
METHODS: We conducted a single-centre, prospective, observational cohort study in 123 patients with low-risk to intermediate-risk acute chest pain suggestive of ACS. MSCT-CA was performed using dual-source 64-slice computed tomography with retrospective electrocardiographic gating. Patients without coronary artery lesions were discharged from the ED. The incidences of death, myocardial infarction and myocardial revascularization were collected during a mid-term follow-up.
RESULTS: According to MSCT-CA, 93 patients (75.6%) had no CAD or coronary artery stenosis less or equal to 50% and 28 patients (22.8%) had stenosis more or equal to 50%. Invasive coronary angiography was performed in 29 patients (23.6%). MSCT-CA accurately identified ten patients (8.13%) with obstructive CAD requiring myocardial revascularization; all had a low TIMI score (0-2) and eight had a low GRACE score. The mean estimated effective dose of MSCT-CA was 16.3±6.4 mSv. Median follow-up was 15 months. No patient (95% CI 0-3.0%) had major adverse cardiovascular events during follow-up.
CONCLUSION: MSCT-CA appears to be a useful initial triage tool in the ED. When the MSCT-CA result is negative, it allows safe early discharge because of its high negative predictive value. In a significant number of cases of low-risk ACS, MSCT-CA detects severe coronary lesions and allows further dedicated diagnostic and therapeutic intervention. Reduction of radiation exposure would help acceptance in clinical practice.
Предметные рубрики MeSH
Acute Coronary SyndromeAdultAgedAged, 80 and overAngina PectorisCardiac-Gated Imaging TechniquesCardiology Service, HospitalCoronary AngiographyCoronary StenosisElectrocardiographyEmergency Service, HospitalFemaleFranceHumansMaleMiddle AgedMultidetector Computed TomographyMyocardial InfarctionMyocardial RevascularizationPatient DischargePredictive Value of TestsPrognosisProspective StudiesRisk AssessmentRisk FactorsSeverity of Illness IndexTime FactorsTriageYoung Adult