Safety and efficiency of outpatient versus emergency department-based coronary CT angiography for evaluation of patients with potential ischemic chest pain.
BACKGROUND
While coronary CT angiography (coronary CTA) may be comparable to standard care in diagnosing acute coronary syndrome (ACS) in emergency department (ED) chest pain patients, it has traditionally been obtained prior to ED discharge and a strategy of delayed outpatient coronary CTA following an ED visit has not been evaluated.


OBJECTIVE
To investigate the safety of discharging stable ED patients and obtaining outpatient CCTA.


METHODS
At two urban Canadian EDs, patients up to 65 years with chest pain but no findings indicating presence of ACS were further evaluated depending upon time of presentation: (1) ED-based coronary CTA during normal working hours, (2) or outpatient coronary CTA within 72 hours at other times. All data were collected prospectively. The primary outcome was the proportion of patients who had an outpatient coronary CTA ordered and had a predefined major adverse cardiac event (MACE) between ED discharge and outpatient CT; secondary outcome was the ED length of stay in both groups.


RESULTS
From July 1, 2012 to June 30, 2014, we enrolled 521 consecutive patients: 350 with outpatient CT and 171 with ED-based CT. Demographics and risk factors were similar in both cohorts. No outpatient CT patients had a MACE prior to coronary CTA. (0.0%, 95% CI 0 to 0.9%) The median length of stay for ED-based evaluation was 6.6 hours (interquartile range 5.4 to 8.3 hours) while the outpatient group had a median length of stay of 7.0 hours (IQR 6.0 to 9.8 hours, n.s.).


CONCLUSIONS
In ED chest pain patients with a low risk of ACS, performing coronary CTA as an outpatient may be a safe strategy.
['Scheuermeyer|Frank X|FX|', 'Grunau|Brian|B|', 'Raju|Rekha|R|', 'Choy|Stephen|S|', 'Naoum|Christopher|C|', 'Blanke|Philipp|P|', 'Hague|Cameron|C|', 'Heilbron|Brett|B|', 'Taylor|Carolyn|C|', 'Kalla|Daniel|D|', 'Christenson|Jim|J|', 'Innes|Grant|G|', 'Hanakova|Michaela|M|', 'Leipsic|Jonathon|J|']
D054058:Acute Coronary Syndrome D000328:Adult D000553:Ambulatory Care D000787:Angina Pectoris D001955:British Columbia D016507:Cardiology Service, Hospital D017023:Coronary Angiography D003324:Coronary Artery Disease D003331:Coronary Vessels D004636:Emergency Service, Hospital D005260:Female D006801:Humans D007902:Length of Stay D008297:Male D008875:Middle Aged D009203:Myocardial Infarction D010351:Patient Discharge D011237:Predictive Value of Tests D011379:Prognosis D011446:Prospective Studies D012307:Risk Factors D013997:Time Factors D014057:Tomography, X-Ray Computed D019037:Urban Health Services
Coronary CT angiography Ischemic chest pain