Effect of race on outcomes following early coronary computed tomographic angiography or standard emergency department evaluation for acute chest pain

Samuel W. Reinhardt, Adefolakemi Babatunde, Eric Novak, David L. Brown

Research output: Contribution to journalArticle

Abstract

Objective: To examine racial differences in outcomes with coronary computed tomographic angiography (CCTA) vs standard emergency department (ED) evaluation for chest pain. Design: Retrospective analysis of the prospective, randomized, multicenter Rule Out Myocardial Ischemia/Infarction by Computer Assisted Tomography (ROMICAT-II) trial. Setting: ED at nine hospitals in the United States. Participants: 940 patients who were Caucasian or African American (AA) presenting to the ED with chest pain. Interventions: CCTA or standard ED evaluation Main Outcome Measures: Length of stay, hospital admission, direct ED discharge, downstream testing and repeat ED visit or hospitalization for recurrent chest pain at 28 days. Safety end points: missed acute coronary syndrome (ACS) and cumulative radiation exposure during the index visit and follow-up period. Results: 659 (66%) patients self-identified as Caucasian and 281 (28%) self-identified as AA. AA were younger and more often female compared with Caucasians, had a higher prevalence of hypertension (64% vs 49%, P<.001) and diabetes (23% vs 14%, P<.001) and a lower prevalence of hyperlipidemia (28% vs 51%, P<.001). ACS was more frequent among Caucasians (10% vs 2%, P<.001). Randomization to CCTA resulted in a reduction in median LOS for Caucasians (7.4 vs 24.7 hours, P<.001) and AA (8.9 vs. 26.3, P<.001; P-interaction=.88). Both AA and Caucasian patients experienced greater radiation exposure and more downstream testing with CCTA compared with standard evaluation. Conclusions: Early CCTA reduced median LOS for both AA and Caucasian patients presenting to the ED with chest pain by approximately 17 hours compared with standard evaluation.

Original languageEnglish
Pages (from-to)517-524
Number of pages8
JournalEthnicity and Disease
Volume28
Issue number4
DOIs
StatePublished - Sep 1 2018

Keywords

  • Acute Coronary Syndromes
  • Cardiac Computed Tomography
  • Chest Pain
  • Emergency Department
  • Ethnicity/Race

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