Recent Studies Show Advantages of Coronary CT Angiography in the Emergency Room

The following was written by Karen G. Ordovas, M.D., Former Assistant Professor in Residence in the Department of Radiology at UCSF.

Recent evidence supports the belief that coronary CT angiography (coronary CTA) is as good as or better than the current clinical standard practice performed to exclude coronary disease in the emergency room.

The evidence comes from two excellent studies that were published within the past several months.  The most recent study, “CT Angiography for Safe Discharge of Patients with Possible Acute Coronary Syndromes”, was published in the April 12 issue of the New England Journal of Medicine.  Check back soon for an upcoming blog post on this research, but for now keep in mind that this was a large multicenter randomized clinical trial on coronary CTA versus standard management for chest pain in low to intermediate risk for acute coronary syndrome.  It’s worth noting that no patients who received CTA had a major cardiac event in the 30 days following their coronary CTA test.  In addition, the length of hospital stay was lower and rate of discharge from the ER was higher in the group that received coronary CTA.

Another solid study was published in the December, 2011 issue of Academic Radiology.  “A Meta-analysis of 64-section Coronary CT Angiography Findings for Predicting 30-day Major Adverse Cardiac Events in Patients Presenting with Symptoms Suggestive of Acute Coronary Syndrome” combined the nine most important studies that have been published on the topic.  The nine studies together included 1,559 patients -- a very large sample size.

The authors of the study reviewed cases where CT was performed on patients at low to intermediate risk for acute coronary syndrome who came to the ER with chest pain. They concluded that if the cardiac imaging exam results are negative, a patient can be sent home with a very good chance of not having heart problems in the next month, which is typically what we are concerned about when they come to the ER with acute chest pain.

Long before publication of this meta-analysis, radiology, cardiology and emergency physicians at UCSF had already developed a clinical protocol on the use of coronary CTA for acute chest pain patients.  For more than a year, if a clinician chose to perform a coronary CTA at UCSF, we had a protocol in place to do that.  This article thus reinforces that coronary CTA is a very good option when managing a patient with acute chest pain in the emergency room.

Furthermore, inside the emergency room at UCSF there is a 64-slice multidetector CT scanner that has very novel capabilities for cardiac imaging and special software for very low radiation studies.  For patients, this means less time in the ER and fewer unnecessary hospital admissions – a real advantage.