Six million people each year in the US go to the emergency department (ED) with acute chest pain. Although only 10-15% of them turn out to have an acute coronary syndrome (ACS), most are admitted to the hospital. Coronary CT angiography (CCTA) has been proposed as a good method to quickly establish the presence or absence of coronary disease and allow many of these patients to return home sooner.
In a presentation at the ACC and in a simultaneous publication in the New England Journal of Medicine, the ACRIN (American College of Radiology Imaging Network) investigators report the findings of ACRIN PA 4005, the largest trial to date of the strategy to use coronary CT angiography to allow more rapid rule out of coronary disease in patients with possible acute coronary syndrome, in which 1,370 patients with chest pain were randomized on a 2:1 basis to either CCTA or conventional treatment.
The primary outcome was the safety at 30 days of patients with a negative CCTA. Among the 640 patients who had a negative CCTA examination, there were no MIs or cardiac deaths at 30 days.
The investigators also observed that, compared with controls, patients in the CCTA group were more likely to be discharged from the emergency department (49.6% versus 22.7%) and to have a shorter length of stay (18 hours versus 24.8 hours). Coronary disease was also more likely to be detected in the CCTA group (9% versus 3.5%).
Utilization of healthcare resources was similar in both groups. The major drawback to CCTA is radiation, but ACRIN investigator Harold Litt pointed out that the radiation dose received by patients for CCTA is now lower than the dose received during nuclear imaging studies.
“We believe that a CCTA-based strategy can safely and efficiently redirect many patients home who would otherwise be admitted,” the authors concluded.