2024/06/18 by Michael Cronin, Michael J. Cronin, Aisling Gill +8
Medicine · #Acute Myocardial Infarction Research #Cardiac Imaging and Diagnostics #Radiation Dose and Imaging
paper · pdf · doi:10.1093/bjr/tqae119
crossref issued 2024/06/18 · crossref published 2024/06/18 · crossref published-online 2024/06/18 · openalex publication_date 2024/06/18 · crossref created 2024/06/18 · openalex created_date 2024/06/19 · crossref deposited 2024/07/18 · crossref published-print 2024/08/01 · crossref indexed 2026/07/30 · openalex updated_date 2026/07/31
OBJECTIVES: An accelerated diagnostic pathway is created to aid the management of low-risk patients presenting to the emergency room with chest pain. Records are taken of patient outcomes and factors influencing physician decision-making between inpatient invasive angiography versus early outpatient cardiac CT angiography. METHODS: A cohort study at 30 days post discharge is undertaken over 1 year. Differences are observed between a population of patients who underwent early outpatient CT and a population of ambulatory haemodynamically stable patients who underwent inpatient fluoroscopic angiography. RESULTS: Totally, 369 patients underwent CT (F = 46%) and 37 underwent angiography (F = 30%). Median outpatient CT was at 14 days. At 30 days, 0 patients suffered mortality or myocardial infarction. Eleven percent were recommended for invasive angiography. Two percent of CT patients underwent coronary revascularization. Median calcium score was 0. Twenty percent of the CT population were commenced on high-potency statin or had their pre-existing statin dose intensified. Calcium score affected a composition of statin commencement, angiography, and revascularization (OR 59, P < .001). Age, troponin, vascular disease, and previous coronary revascularization appeared to influence choice between coronary computed tomography angiography (CCTA) and invasive angiography. CONCLUSION: An accelerated diagnostic pathway for outpatient cardiac CT for chest pain resulted in no mortality or myocardial infarction, with a low level of downstream testing and coronary revascularization. ADVANCES IN KNOWLEDGE: At a median time to CCTA of 14 days post discharge from the emergency department, there is no effect on patient major adverse cardiac events.