What proportion of patients with chest pain are potentially suitable for computed tomography coronary angiography?

Hamid, Sulieman, Bainbridge, Fiona, Kelly, Anne-Maree and Kerr, Debra 2010, What proportion of patients with chest pain are potentially suitable for computed tomography coronary angiography?, American journal of emergency medicine, vol. 28, no. 4, pp. 494-498, doi: 10.1016/j.ajem.2009.03.005.

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Title What proportion of patients with chest pain are potentially suitable for computed tomography coronary angiography?
Author(s) Hamid, Sulieman
Bainbridge, Fiona
Kelly, Anne-Maree
Kerr, DebraORCID iD for Kerr, Debra orcid.org/0000-0002-2956-2432
Journal name American journal of emergency medicine
Volume number 28
Issue number 4
Start page 494
End page 498
Total pages 5
Publisher Elsevier
Place of publication Amsterdam, The Netherlands
Publication date 2010-05
ISSN 0735-6757
Keyword(s) Acute Coronary Syndrome
Chest Pain
Coronary Angiography
Coronary Artery Disease
Middle Aged
Retrospective Studies
Risk Factors
Tomography, X-Ray Computed
Summary OBJECTIVES: Serial electrocardiographic and biomarker data are used to rule out acute coronary syndrome (ACS) in emergency department (ED) patients with chest pain. These do not identify coronary artery disease (CAD). Functional tests are often used but have limitations. Multislice computed tomography coronary angiography (MSCT-CA) is evolving rapidly, raising the possibility of fast, accurate, and relatively noninvasive anatomical testing for CAD. We aimed to quantify the proportion of ED rule-out ACS patients suitable for MSCT-CA.

METHODS: This retrospective cohort study (by explicit record review) included adult patients who underwent a rule-out ACS process in ED-associated short-stay units. Data collected included demographics, electrocardiographic and biomarker data, contraindications/factors likely to make MSCT-CA unsuccessful or difficult to interpret including irregular heart rhythm, high pulse rate (with rate control contraindicated), renal or thyroid disease, contrast allergy, metformin use, pregnancy, and already confirmed CAD. Outcome of interest was the proportion of patients suitable for MSCT-CA. Data analysis is by descriptive statistics.

RESULTS: Four hundred sixty patients were studied (63% male; median age, 63 years). Forty-nine percent (224/460; 95% confidence interval, 44%-53%) were suitable for MSCT-CA. One hundred eighty-one (39%) already had known CAD. Reasons for unsuitability of the remainder were metformin use 18 (6%), irregular heart rhythm 15 (5%), renal dysfunction 12 (4%), high pulse rate with contraindications to rate control 8 (3%), thyroid disease 7 (3%), and contrast allergy 2 (0.7%).

CONCLUSION: Approximately half of ED patients with chest pain who have underwent ACS rule-out were potentially suitable for MSCT-CA to identify CAD. The best use of MSCT-CA in the investigation of patients with chest pain requires further clarification.
Language eng
DOI 10.1016/j.ajem.2009.03.005
Field of Research 110399 Clinical Sciences not elsewhere classified
1103 Clinical Sciences
Socio Economic Objective 929999 Health not elsewhere classified
HERDC Research category C1.1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2010, Crown Copyright
Persistent URL http://hdl.handle.net/10536/DRO/DU:30089870

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