Usefulness of 64-slice multidetector computed tomography as an initial diagnostic approach in patients with acute chest pain

Sung A. Chang, Sang Il Choi, Eue Keun Choi, Hyung Kwan Kim, Jin Wook Jung, Eun Ju Chun, Kyu Seok Kim, Young Seok Cho, Woo Young Chung, Tae Jin Youn, In Ho Chae, Dong Ju Choi, Hyuk Jae Chang

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

Background: Recently, multidetector computed tomography (MDCT) has been proposed as an accurate diagnostic tool to evaluate for coronary artery disease. However, the role of MDCT as part of the initial diagnostic for evaluating acute chest pain is less well established. Methods: We prospectively enrolled patients presenting with acute chest pain to the emergency department (ED) and risk stratified them based on the pretest probability for an acute coronary syndrome (ACS): (1) very low, (2) low, (3) intermediate, (4) high, and (5) very high or definite. After exclusion of very low and very high risk patients, 268 patients were randomized to either immediate 64-slice cardiac MDCT or a conventional diagnostic strategy. Number of admissions, ED and hospital length of stay (LOS), and major adverse cardiac events over 30 days of follow-up were compared between the strategies based on the pretest probability for ACS. Results: The number of patients ultimately diagnosed with an ACS did not differ between the 2 strategies. Emergency department LOS and total admissions were not different between strategies. Patients in the MDCT-based strategy had a decreased hospital LOS (P = .049) and fewer admissions deemed unnecessary (P = .007). Reductions in unnecessary admissions were more prominent in intermediate-risk patients (P = .015). None of the patients discharged from the ED in the MDCT-based strategy experienced major adverse cardiac events at follow-up. Conclusion: Use of an MDCT-based strategy in the ED as part of the initial diagnostic approach for patients presenting with acute chest pain is safe and efficiently reduces avoidable admissions in patients with an intermediate pretest probability for ACS.

Original languageEnglish
Pages (from-to)375-383
Number of pages9
JournalAmerican heart journal
Volume156
Issue number2
DOIs
Publication statusPublished - 2008 Aug 1

Fingerprint

Multidetector Computed Tomography
Acute Pain
Chest Pain
Hospital Emergency Service
Length of Stay
Acute Coronary Syndrome
Patient Admission
Coronary Artery Disease

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Chang, Sung A. ; Choi, Sang Il ; Choi, Eue Keun ; Kim, Hyung Kwan ; Jung, Jin Wook ; Chun, Eun Ju ; Kim, Kyu Seok ; Cho, Young Seok ; Chung, Woo Young ; Youn, Tae Jin ; Chae, In Ho ; Choi, Dong Ju ; Chang, Hyuk Jae. / Usefulness of 64-slice multidetector computed tomography as an initial diagnostic approach in patients with acute chest pain. In: American heart journal. 2008 ; Vol. 156, No. 2. pp. 375-383.
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title = "Usefulness of 64-slice multidetector computed tomography as an initial diagnostic approach in patients with acute chest pain",
abstract = "Background: Recently, multidetector computed tomography (MDCT) has been proposed as an accurate diagnostic tool to evaluate for coronary artery disease. However, the role of MDCT as part of the initial diagnostic for evaluating acute chest pain is less well established. Methods: We prospectively enrolled patients presenting with acute chest pain to the emergency department (ED) and risk stratified them based on the pretest probability for an acute coronary syndrome (ACS): (1) very low, (2) low, (3) intermediate, (4) high, and (5) very high or definite. After exclusion of very low and very high risk patients, 268 patients were randomized to either immediate 64-slice cardiac MDCT or a conventional diagnostic strategy. Number of admissions, ED and hospital length of stay (LOS), and major adverse cardiac events over 30 days of follow-up were compared between the strategies based on the pretest probability for ACS. Results: The number of patients ultimately diagnosed with an ACS did not differ between the 2 strategies. Emergency department LOS and total admissions were not different between strategies. Patients in the MDCT-based strategy had a decreased hospital LOS (P = .049) and fewer admissions deemed unnecessary (P = .007). Reductions in unnecessary admissions were more prominent in intermediate-risk patients (P = .015). None of the patients discharged from the ED in the MDCT-based strategy experienced major adverse cardiac events at follow-up. Conclusion: Use of an MDCT-based strategy in the ED as part of the initial diagnostic approach for patients presenting with acute chest pain is safe and efficiently reduces avoidable admissions in patients with an intermediate pretest probability for ACS.",
author = "Chang, {Sung A.} and Choi, {Sang Il} and Choi, {Eue Keun} and Kim, {Hyung Kwan} and Jung, {Jin Wook} and Chun, {Eun Ju} and Kim, {Kyu Seok} and Cho, {Young Seok} and Chung, {Woo Young} and Youn, {Tae Jin} and Chae, {In Ho} and Choi, {Dong Ju} and Chang, {Hyuk Jae}",
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Chang, SA, Choi, SI, Choi, EK, Kim, HK, Jung, JW, Chun, EJ, Kim, KS, Cho, YS, Chung, WY, Youn, TJ, Chae, IH, Choi, DJ & Chang, HJ 2008, 'Usefulness of 64-slice multidetector computed tomography as an initial diagnostic approach in patients with acute chest pain', American heart journal, vol. 156, no. 2, pp. 375-383. https://doi.org/10.1016/j.ahj.2008.03.016

Usefulness of 64-slice multidetector computed tomography as an initial diagnostic approach in patients with acute chest pain. / Chang, Sung A.; Choi, Sang Il; Choi, Eue Keun; Kim, Hyung Kwan; Jung, Jin Wook; Chun, Eun Ju; Kim, Kyu Seok; Cho, Young Seok; Chung, Woo Young; Youn, Tae Jin; Chae, In Ho; Choi, Dong Ju; Chang, Hyuk Jae.

In: American heart journal, Vol. 156, No. 2, 01.08.2008, p. 375-383.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Usefulness of 64-slice multidetector computed tomography as an initial diagnostic approach in patients with acute chest pain

AU - Chang, Sung A.

AU - Choi, Sang Il

AU - Choi, Eue Keun

AU - Kim, Hyung Kwan

AU - Jung, Jin Wook

AU - Chun, Eun Ju

AU - Kim, Kyu Seok

AU - Cho, Young Seok

AU - Chung, Woo Young

AU - Youn, Tae Jin

AU - Chae, In Ho

AU - Choi, Dong Ju

AU - Chang, Hyuk Jae

PY - 2008/8/1

Y1 - 2008/8/1

N2 - Background: Recently, multidetector computed tomography (MDCT) has been proposed as an accurate diagnostic tool to evaluate for coronary artery disease. However, the role of MDCT as part of the initial diagnostic for evaluating acute chest pain is less well established. Methods: We prospectively enrolled patients presenting with acute chest pain to the emergency department (ED) and risk stratified them based on the pretest probability for an acute coronary syndrome (ACS): (1) very low, (2) low, (3) intermediate, (4) high, and (5) very high or definite. After exclusion of very low and very high risk patients, 268 patients were randomized to either immediate 64-slice cardiac MDCT or a conventional diagnostic strategy. Number of admissions, ED and hospital length of stay (LOS), and major adverse cardiac events over 30 days of follow-up were compared between the strategies based on the pretest probability for ACS. Results: The number of patients ultimately diagnosed with an ACS did not differ between the 2 strategies. Emergency department LOS and total admissions were not different between strategies. Patients in the MDCT-based strategy had a decreased hospital LOS (P = .049) and fewer admissions deemed unnecessary (P = .007). Reductions in unnecessary admissions were more prominent in intermediate-risk patients (P = .015). None of the patients discharged from the ED in the MDCT-based strategy experienced major adverse cardiac events at follow-up. Conclusion: Use of an MDCT-based strategy in the ED as part of the initial diagnostic approach for patients presenting with acute chest pain is safe and efficiently reduces avoidable admissions in patients with an intermediate pretest probability for ACS.

AB - Background: Recently, multidetector computed tomography (MDCT) has been proposed as an accurate diagnostic tool to evaluate for coronary artery disease. However, the role of MDCT as part of the initial diagnostic for evaluating acute chest pain is less well established. Methods: We prospectively enrolled patients presenting with acute chest pain to the emergency department (ED) and risk stratified them based on the pretest probability for an acute coronary syndrome (ACS): (1) very low, (2) low, (3) intermediate, (4) high, and (5) very high or definite. After exclusion of very low and very high risk patients, 268 patients were randomized to either immediate 64-slice cardiac MDCT or a conventional diagnostic strategy. Number of admissions, ED and hospital length of stay (LOS), and major adverse cardiac events over 30 days of follow-up were compared between the strategies based on the pretest probability for ACS. Results: The number of patients ultimately diagnosed with an ACS did not differ between the 2 strategies. Emergency department LOS and total admissions were not different between strategies. Patients in the MDCT-based strategy had a decreased hospital LOS (P = .049) and fewer admissions deemed unnecessary (P = .007). Reductions in unnecessary admissions were more prominent in intermediate-risk patients (P = .015). None of the patients discharged from the ED in the MDCT-based strategy experienced major adverse cardiac events at follow-up. Conclusion: Use of an MDCT-based strategy in the ED as part of the initial diagnostic approach for patients presenting with acute chest pain is safe and efficiently reduces avoidable admissions in patients with an intermediate pretest probability for ACS.

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