Computed tomography coronary angiography for rapid disposition of low-risk emergency department patients with chest pain syndromes
Computed tomography coronary angiography for rapid disposition of low-risk emergency department patients with chest pain syndromes
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DOI：
10.1197/j.aem.2006.09.051
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发表时间：
2007-02-01
影响因子：
4.4
通讯作者：
Baxt, William G.
中科院分区：
文献类型：
--
作者：
Hollander, Judd E.;Litt, Harold I.;Baxt, William G.
背景：近期心导管插管正常的患者发生缺血性胸痛并发症的风险较低。CT冠状动脉造影与心导管检查冠状动脉狭窄有很高的相关性。因此，研究人员的急诊科（ED）将CT冠状动脉造影纳入对低危胸痛患者的评估。目的：报告采用该策略评估的前54例患者的30天心血管事件发生率。方法：心电图无急性缺血的低危胸痛患者（TIMI评分为2分及以下）在急诊科行CT冠状动脉造影，如CT冠状动脉造影阴性，则出院回家。主要结局为急诊出院后30天内死亡和心肌梗死，通过电话随访和记录回顾确定。数据以95%置信区间（ci）的发生频率百分比表示。结果：54例患者中，CT冠状动脉造影后，46例（85%）患者立即出院，30天内无心血管并发症发生。8例患者行CT冠状动脉造影后入院，1例狭窄0 ~ 70%，5例狭窄50 ~ 69%，2例狭窄0 ~ 49%。3例患者接受了进一步的无创检查；1例有可逆性缺血，导管置入证实了CT冠状动脉造影的结果。所有患者随访30天，在指数住院期间或30天随访期间均无不良事件发生（95% CI = 0 ~ 6.6%）。结论：当CT冠状动脉造影用于临床评估低危胸痛的ED患者时，可以安全地让阴性研究的患者快速出院。需要进一步研究以确定该方法的安全性和成本效益。
Background: Patients with recent normal cardiac catheterization are at low risk for complications of ischemic chest pain. Computed tomography (CT) coronary angiography has high correlation with cardiac catheterization for detection of coronary stenosis. Therefore, the investigators' emergency department (ED) incorporated CT coronary angiography into the evaluation of low-risk patients with chest pain.Objectives: To report on the 30-day cardiovascular event rates of the first 54 patients evaluated by this strategy.Methods: Low-risk chest pain patients (Thrombolysis In Myocardial Infarction [TIMI] score of 2 or less) without acute ischemia on an electrocardiogram had CT coronary angiography performed in the ED. If the CT coronary angiography was negative, the patient was discharged home. The main outcomes were death and myocardial infarction within 30 days of ED discharge, as determined by telephone follow up and record review. Data are presented as percentage frequency of occurrence with 95% confidence intervals (CIs).Results: Of the 54 patients evaluated, after CT coronary angiography, 46 patients (85%) were immediately released from the ED, and none had cardiovascular complications within 30 days. Eight patients were admitted after CT coronary angiography: one had > 70% stenosis, five patients had 50%-69% stenosis, and two had 0-49% stenosis. Three patients had further noninvasive testing; one had reversible ischemia, and catheterization confirmed the results of CT coronary angiography. All patients were followed for 30 days, and none (0; 95% CI = 0 to 6.6%) had an adverse event during index hospitalization or at 30-day follow up.Conclusions: When used in the clinical setting for the evaluation of ED patients with low-risk chest pain, CT coronary angiography may safely allow rapid discharge of patients with negative studies. Further study to conclusively determine the safety and cost effectiveness of this approach is warranted.