OBJECTIVES:
Coronary computerized tomographic
angiography (CTA) has high
correlation with
cardiac catheterization and has been shown to be safe and
cost-effective when used for rapid evaluation of low-risk
chest pain patients from the
emergency department (ED). The long-term outcome of patients discharged from the ED with negative
coronary CTA has not been well studied. METHODS: The authors prospectively evaluated consecutive low- to intermediate-risk patients who received
coronary CTA in the ED for evaluation of a potential
acute coronary syndrome (ACS). Patients with
cocaine use, known cancer, and significant
comorbidity reducing
life expectancy and those found to have significant disease (
stenosis > or = 50% or
ejection fraction < 30%) were excluded. Demographics, medical and
cardiac history, labs, and
electrocardiogram (
ECG) results were collected. Patients were followed by telephone contact and record review for 1 year. The main outcome was 1-year
cardiovascular death or nonfatal
acute myocardial infarction (AMI). RESULTS: Of 588 patients who received
coronary CTA in the ED, 481 met study criteria. They had a
mean (+/-SD) age of 46.1 (+/-8.8) years, 63% were black or African American, and 60% were female. There were 53 patients (11%) rehospitalized and 51 patients (11%) who received further diagnostic testing (stress or catheterization) over the subsequent year. There was one death (0.2%; 95%
confidence interval [CI] = 0.01% to 1.15%) with unclear
etiology, no AMI (0%; 95% CI = 0 to 0.76%), and no
revascularization procedures (0%; 95% CI = 0 to 0.76%) during this time period. CONCLUSIONS: Low- to intermediate-risk patients with a
Thrombosis In
Myocardial Infarction (
TIMI) score of 0 to 2 who present to the ED with potential ACS and have a negative
coronary CTA have a very low
likelihood of
cardiovascular events over the ensuing year.
