Coronary CT angiography versus standard evaluation in acute chest pain

Udo Hoffmann, Quynh A. Truong, David A. Schoenfeld, Eric T. Chou, Pamela K. Woodard, John T. Nagurney, J. Hector Pope, Thomas H. Hauser, Charles S. White, Scott G. Weiner, Shant Kalanjian, Michael E. Mullins, Issam Mikati, W. Frank Peacock, Pearl Zakroysky, Douglas Hayden, Alexander Goehler, Hang Lee, G. Scott Gazelle, Stephen D. WiviottJerome L. Fleg, James E. Udelson

Research output: Contribution to journalArticle

504 Scopus citations

Abstract

BACKGROUND: It is unclear whether an evaluation incorporating coronary computed tomographic angiography (CCTA) is more effective than standard evaluation in the emergency department in patients with symptoms suggestive of acute coronary syndromes. METHODS: In this multicenter trial, we randomly assigned patients 40 to 74 years of age with symptoms suggestive of acute coronary syndromes but without ischemic electrocardiographic changes or an initial positive troponin test to early CCTA or to standard evaluation in the emergency department on weekdays during daylight hours between April 2010 and January 2012. The primary end point was length of stay in the hospital. Secondary end points included rates of discharge from the emergency department, major adverse cardiovascular events at 28 days, and cumulative costs. Safety end points were undetected acute coronary syndromes. RESULTS: The rate of acute coronary syndromes among 1000 patients with a mean (±SD) age of 54±8 years (47% women) was 8%. After early CCTA, as compared with standard evaluation, the mean length of stay in the hospital was reduced by 7.6 hours (P<0.001) and more patients were discharged directly from the emergency department (47% vs. 12%, P<0.001). There were no undetected acute coronary syndromes and no significant differences in major adverse cardiovascular events at 28 days. After CCTA, there was more downstream testing and higher radiation exposure. The cumulative mean cost of care was similar in the CCTA group and the standardevaluation group ($4,289 and $4,060, respectively; P = 0.65). CONCLUSIONS: In patients in the emergency department with symptoms suggestive of acute coronary syndromes, incorporating CCTA into a triage strategy improved the efficiency of clinical decision making, as compared with a standard evaluation in the emergency department, but it resulted in an increase in downstream testing and radiation exposure with no decrease in the overall costs of care.

Original languageEnglish
Pages (from-to)299-308
Number of pages10
JournalNew England Journal of Medicine
Volume367
Issue number4
DOIs
StatePublished - Jul 26 2012

Fingerprint Dive into the research topics of 'Coronary CT angiography versus standard evaluation in acute chest pain'. Together they form a unique fingerprint.

  • Cite this

    Hoffmann, U., Truong, Q. A., Schoenfeld, D. A., Chou, E. T., Woodard, P. K., Nagurney, J. T., Pope, J. H., Hauser, T. H., White, C. S., Weiner, S. G., Kalanjian, S., Mullins, M. E., Mikati, I., Peacock, W. F., Zakroysky, P., Hayden, D., Goehler, A., Lee, H., Gazelle, G. S., ... Udelson, J. E. (2012). Coronary CT angiography versus standard evaluation in acute chest pain. New England Journal of Medicine, 367(4), 299-308. https://doi.org/10.1056/NEJMoa1201161