Usefulness of 64-slice multidetector computed tomography as an initial diagnostic approach in patients with acute chest pain
Usefulness of 64-slice multidetector computed tomography as an initial diagnostic approach in patients with acute chest pain
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DOI：
10.1016/j.ahj.2008.03.016
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发表时间：
2008-08-01
影响因子：
4.8
通讯作者：
Chang, Hyuk-Jae
中科院分区：
文献类型：
--
作者：
Chang, Sung-A;Choi, Sang Il;Chang, Hyuk-Jae
背景：近年来，多排螺旋CT（MDCT）被认为是评价冠状动脉疾病的准确诊断工具。然而，MDCT作为评估急性胸痛的初步诊断的一部分的作用还不太确定。方法我们前瞻性地招募了急诊科（艾德）的急性胸痛患者，并根据急性冠状动脉综合征（ACS）的预测试概率对他们进行风险分层：（1）非常低，（2）低，（3）中等，（4）高，（5）非常高或明确。在排除极低和极高风险患者后，268例患者随机接受即刻64层心脏MDCT或常规诊断策略。入院人数，艾德和住院时间（LOS），并超过30天的后续行动之间的主要不良心脏事件进行了比较的基础上的预检验概率为ACS.Results的患者人数最终诊断为ACS之间的2个策略没有显着差异。急诊科LOS和总入院率在不同策略之间没有差异。在MDCT为基础的策略中，患者的住院时间减少（P = 0.049），不必要的住院人数减少（P = 0.007）。不必要的入院减少在中危患者中更为突出（P = 0.015）。从艾德出院的患者在MDCT为基础的战略经历了重大的不良心脏事件follow-up.Conclusion使用MDCT为基础的战略，在艾德的一部分，对急性胸痛患者的初步诊断方法是安全的，有效地减少了可避免的住院患者的中间预测试的ACS的概率。
Background Recently, multidetector computed tomography (MDCT) has been proposed as an accurate diagnostic tool to evaluate for coronary artery disease. However, the role of MDCT as part of the initial diagnostic for evaluating acute chest pain is less well established.Methods We prospectively enrolled patients presenting with acute chest pain to the emergency department (ED) and risk stratified them based on the pretest probability for an acute coronary syndrome (ACS): (1) very low, (2) low, (3) intermediate, (4) high, and (5) very high or definite. After exclusion of very low and very high risk patients, 268 patients were randomized to either immediate 64-slice cardiac MDCT or a conventional diagnostic strategy. Number of admissions, ED and hospital length of stay (LOS), and major adverse cardiac events over 30 days of follow-up were compared between the strategies based on the pretest probability for ACS.Results The number of patients ultimately diagnosed with an ACS did not differ between the 2 strategies. Emergency department LOS and total admissions were not different between strategies. Patients, in the MDCT-based strategy had a decreased hospital LOS (P = .049) and fewer admissions deemed unnecessary (P = .007). Reductions in unnecessary admissions were more prominent in intermediate-risk patients (P = .015). None of the patients discharged from the ED in the MDCT-based strategy experienced major adverse cardiac events at follow-up.Conclusion Use of an MDCT-based strategy in the ED as part of the initial diagnostic approach for patients presenting with acute chest pain is safe and efficiently reduces avoidable admissions in patients with an intermediate pretest probability for ACS.