Coronary CT angiography versus standard evaluation in acute chest pain.
Coronary CT angiography versus standard evaluation in acute chest pain.
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DOI：
10.1056/nejmoa1201161
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发表时间：
2012-07-26
期刊：
影响因子：
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通讯作者：
ROMICAT-II Investigators
中科院分区：
文献类型：
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作者：
Hoffmann U;Truong QA;Schoenfeld DA;Chou ET;Woodard PK;Nagurney JT;Pope JH;Hauser TH;White CS;Weiner SG;Kalanjian S;Mullins ME;Mikati I;Peacock WF;Zakroysky P;Hayden D;Goehler A;Lee H;Gazelle GS;Wiviott SD;Fleg JL;Udelson JE;ROMICAT-II Investigators
目前尚不清楚在急诊科对有急性冠状动脉综合征症状的患者进行冠状动脉计算机断层血管造影（CCTA）评估是否比标准评估更有效。在这项多中心试验中，我们将年龄在40 - 74岁、有急性冠脉综合征症状但无缺血性心电图改变或初始肌钙蛋白试验阳性的患者随机分配至早期CCTA或2010年4月至2012年1月期间在工作日白天在急诊科进行标准评估。主要终点是住院时间。次要终点包括急诊出院率、28天主要不良心血管事件和累积费用。安全性终点为未检出的急性冠状动脉综合征。在1000例平均（±SD）年龄为54±8岁（47%为女性）的患者中，急性冠状动脉综合征的发生率为8%。早期CCTA后，与标准评估相比，平均住院时间缩短了7.6小时（P<0.001），更多的患者直接从急诊科出院（47% vs. 12%，P<0.001）。在28天时，没有未检测到的急性冠状动脉综合征，主要不良心血管事件也没有显著差异。CCTA后，下游测试更多，辐射暴露更高。CCTA组和标准评估组的累计平均护理费用相似（分别为4，289美元和4，060美元; P=0.65）。在急诊科有急性冠状动脉综合征症状的患者中，与急诊科的标准评估相比，将CCTA纳入分诊策略提高了临床决策的效率，但它导致下游检测和辐射暴露增加，而没有降低整体护理成本。（由国家心脏、肺和血液研究所资助; ROMICAT-II ClinicalTrials.gov编号，NCT 01084239。
It is unclear whether an evaluation incorporating coronary computed tomographic angiography (CCTA) is more effective than standard evaluation in the emergency department in patients with symptoms suggestive of acute coronary syndromes. In this multicenter trial, we randomly assigned patients 40 to 74 years of age with symptoms suggestive of acute coronary syndromes but without ischemic electrocardiographic changes or an initial positive troponin test to early CCTA or to standard evaluation in the emergency department on weekdays during daylight hours between April 2010 and January 2012. The primary end point was length of stay in the hospital. Secondary end points included rates of discharge from the emergency department, major adverse cardiovascular events at 28 days, and cumulative costs. Safety end points were undetected acute coronary syndromes. The rate of acute coronary syndromes among 1000 patients with a mean (±SD) age of 54±8 years (47% women) was 8%. After early CCTA, as compared with standard evaluation, the mean length of stay in the hospital was reduced by 7.6 hours (P<0.001) and more patients were discharged directly from the emergency department (47% vs. 12%, P<0.001). There were no undetected acute coronary syndromes and no significant differences in major adverse cardiovascular events at 28 days. After CCTA, there was more downstream testing and higher radiation exposure. The cumulative mean cost of care was similar in the CCTA group and the standard-evaluation group ($4,289 and $4,060, respectively; P=0.65). In patients in the emergency department with symptoms suggestive of acute coronary syndromes, incorporating CCTA into a triage strategy improved the efficiency of clinical decision making, as compared with a standard evaluation in the emergency department, but it resulted in an increase in downstream testing and radiation exposure with no decrease in the overall costs of care. (Funded by the National Heart, Lung, and Blood Institute; ROMICAT-II ClinicalTrials.gov number, NCT01084239.)