Screening with coronary computerized tomographic angiography (CTA) is a safe and effective way to rule out serious cardiovascular disease in patients who come to hospital emergency rooms with chest pain, according to the first long-term study.
Chest pain is a common and costly health complaint, which makes a large number of patients to reach hospital emergency departments.
AdvertisementAlthough just five to 15 percent of those patients are found to be suffering from heart attacks or other cardiac diseases, more than half are admitted to the hospital for observation and further testing.
Researchers from the University of Pennsylvania School of Medicine found that CTA streamlines the process and provides a faster, and less expensive way to evaluate which patients have an acute coronary syndrome that require treatment.
"The ability to rapidly determine that there is nothing seriously wrong allows us to provide reassurance to the patient and to help reduce crowding in the emergency department. The use of this test is a win-win," said lead author Dr. Judd Hollander, professor and clinical research director in Penn's department of Emergency Medicine.
None of the patients enrolled in the trial after getting a negative scan - a scan showing no evidence of dangerous blockages in the coronary arteries - had heart attacks or required bypass surgery or placement of cardiac stents in the year following their test.
According to the authors, the findings provide a roadmap for how to appropriately and cost-effectively use this advanced imaging technology, which generates lifelike, three-dimensional photos of the heart and the matrix of blood vessels that surround it.
Investigators followed 481 patients who received negative CTA scans for one year after their hospital visit-11 percent of patients were rehospitalized and 11 percent received additional cardiac testing - stress tests or cardiac catheterizations - over the following year.
But, none had heart attacks or needed revascularization procedures to prop open blocked coronary arteries, while one patient in the study died of an unrelated cause during the year.
In earlier studies, it was shown that CTA is both a quicker and less expensive way to screen low-risk chest pain patients than conventional testing methods.
Those studies also showed that CTA helps get patients home faster.
"The evidence now clearly shows that when used in appropriate patients in the ED, we can safely and rapidly reduce hospital admission and save money. It seems time to make a national coverage decision that will facilitate coronary CTA in the emergency department," said Hollander.
The study was presented at the Society for Academic Emergency Medicine's annual conference.
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