Clinical implementation of an emergency department coronary computed tomographic angiography protocol for triage of patients with suspected acute coronary syndrome.
Clinical implementation of an emergency department coronary computed tomographic angiography protocol for triage of patients with suspected acute coronary syndrome.
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DOI：
10.1007/s00330-016-4562-5
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发表时间：
2017-07
影响因子：
5.9
通讯作者：
MGH Emergency Cardiac CTA Program Contributors
中科院分区：
文献类型：
--
作者：
Ghoshhajra BB;Takx RAP;Staziaki PV;Vadvala H;Kim P;Neilan TG;Meyersohn NM;Bittner D;Janjua SA;Mayrhofer T;Greenwald JL;Truong QA;Abbara S;Brown DFM;Januzzi JL;Francis S;Nagurney JT;Hoffmann U;MGH Emergency Cardiac CTA Program Contributors
在 3 年的临床经验中评估急诊科 (ED) 冠状动脉计算机断层扫描血管造影 (CTA) 的效率和安全性。对怀疑患有急性冠状动脉综合征 (ACS) 的连续 ED 患者进行冠状动脉 CTA 的单中心登记。主要结局是冠状动脉 CTA 的效率，定义为住院时间。次要安全终点定义为下游检测率、侵入性冠状动脉造影（ICA）正常率、无漏诊 ACS、随访期间主要不良心脏事件（MACE）以及指数辐射暴露。连续 1022 名疑似 ACS 患者被转诊进行临床冠状动脉 CTA。总体而言，出院回家的中位时间为 10.5 (5.7–24.1) 小时。患者处理情况为：42.7% 直接从急诊室出院，43.2% 从急诊室出院，14.1% 入院。住院期间 ACS 发生率为 9.1%。 192 名患者接受了额外的诊断成像，77 名患者接受了 ICA。与 ICA 相比，CTA 的阳性预测值为 78.9% (95%-CI 68.1–87.5%)。 CT 辐射暴露中位数为 4.0 (2.5–5.8) mSv。没有遗漏 ACS； CTA 阴性后随访时的 MACE 为 0.2%。在经验丰富的三级医疗机构中进行冠状动脉 CTA 可以对怀疑患有 ACS 的患者进行高效、安全的管理。
To evaluate the efficiency and safety of emergency department (ED) coronary computed tomography angiography (CTA) during a 3-year clinical experience. Single-center registry of coronary CTA in consecutive ED patients with suspicion of acute coronary syndrome (ACS). The primary outcome was efficiency of coronary CTA defined as the length of hospitalization. Secondary endpoints of safety were defined as the rate of downstream testing, normalcy rates of invasive coronary angiography (ICA), absence of missed ACS, and major adverse cardiac events (MACE) during follow-up, and index radiation exposure. 1022 consecutive patients were referred for clinical coronary CTA with suspicion of ACS. Overall, median time to discharge home was 10.5 (5.7–24.1) hours. Patient disposition was 42.7% direct discharge from the ED, 43.2% discharge from emergency unit, and 14.1% hospital admission. ACS rate during index hospitalization was 9.1%. 192 patients underwent additional diagnostic imaging and 77 underwent ICA. The positive predictive value of CTA compared to ICA was 78.9% (95%-CI 68.1–87.5%). Median CT radiation exposure was 4.0 (2.5–5.8) mSv. No ACS was missed; MACE at follow-up after negative CTA was 0.2%. Coronary CTA in an experienced tertiary care setting allows for efficient and safe management of patients with suspicion for ACS.
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DOI：
10.1177/1745691612459058
发表时间：
2012-11
期刊：
Perspectives on psychological science : a journal of the Association for Psychological Science
影响因子：
--
作者：
Nosek BA;Spies JR;Motyl M
通讯作者：
Motyl M
影响因子：
4
作者：
McCarney, Rob;Warner, James;Fisher, Peter
通讯作者：
Fisher, Peter
影响因子：
6.2
作者：
Chase, Maureen;Robey, Jennifer L.;Hollander, Judd E.
通讯作者：
Hollander, Judd E.
影响因子：
4.4
作者：
Pollack, CV;Sites, FD;Hollander, JE
通讯作者：
Hollander, JE
影响因子：
39
作者：
Than, Martin;Aldous, Sally;Richards, A. Mark
通讯作者：
Richards, A. Mark