| CT angiography for safe discharge of patients with possible acute coronary syndromes. | |
| | |
MedLine Citation:
|
PMID: 22449295 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: Admission rates among patients presenting to emergency departments with possible acute coronary syndromes are high, although for most of these patients, the symptoms are ultimately found not to have a cardiac cause. Coronary computed tomographic angiography (CCTA) has a very high negative predictive value for the detection of coronary disease, but its usefulness in determining whether discharge of patients from the emergency department is safe is not well established. METHODS: We randomly assigned low-to-intermediate-risk patients presenting with possible acute coronary syndromes, in a 2:1 ratio, to undergo CCTA or to receive traditional care. Patients were enrolled at five centers in the United States. Patients older than 30 years of age with a Thrombolysis in Myocardial Infarction risk score of 0 to 2 and signs or symptoms warranting admission or testing were eligible. The primary outcome was safety, assessed in the subgroup of patients with a negative CCTA examination, with safety defined as the absence of myocardial infarction and cardiac death during the first 30 days after presentation. RESULTS: We enrolled 1370 subjects: 908 in the CCTA group and 462 in the group receiving traditional care. The baseline characteristics were similar in the two groups. Of 640 patients with a negative CCTA examination, none died or had a myocardial infarction within 30 days (0%; 95% confidence interval [CI], 0 to 0.57). As compared with patients receiving traditional care, patients in the CCTA group had a higher rate of discharge from the emergency department (49.6% vs. 22.7%; difference, 26.8 percentage points; 95% CI, 21.4 to 32.2), a shorter length of stay (median, 18.0 hours vs. 24.8 hours; P<0.001), and a higher rate of detection of coronary disease (9.0% vs. 3.5%; difference, 5.6 percentage points; 95% CI, 0 to 11.2). There was one serious adverse event in each group. CONCLUSIONS: A CCTA-based strategy for low-to-intermediate-risk patients presenting with a possible acute coronary syndrome appears to allow the safe, expedited discharge from the emergency department of many patients who would otherwise be admitted. (Funded by the Commonwealth of Pennsylvania Department of Health and the American College of Radiology Imaging Network Foundation; ClinicalTrials.gov number, NCT00933400.). |
| | |
Authors:
|
Harold I Litt; Constantine Gatsonis; Brad Snyder; Harjit Singh; Chadwick D Miller; Daniel W Entrikin; James M Leaming; Laurence J Gavin; Charissa B Pacella; Judd E Hollander |
Related Documents
:
|
22548915 - The importance of intima-media thickness (imt) measurements in monitoring of atheroscle... 21925635 - Changes in left ventricular diastolic function of asymptomatic hereditary hemochromatos... 22595405 - Appropriateness of coronary revascularization for patients without acute coronary syndr... 21995675 - Selective cerebro-myocardial perfusion in complex congenital aortic arch pathology: a n... 9066385 - Assessment of continuous cold blood cardioplegia in coronary artery bypass grafting. 9595215 - Influence of smoking status on progression of endothelial dysfunction. trend investigat... |
Publication Detail:
|
Type: Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't Date: 2012-03-26 |
Journal Detail:
|
Title: The New England journal of medicine Volume: 366 ISSN: 1533-4406 ISO Abbreviation: N. Engl. J. Med. Publication Date: 2012 Apr |
Date Detail:
|
Created Date: 2012-04-12 Completed Date: 2012-04-19 Revised Date: 2013-01-08 |
Medline Journal Info:
|
Nlm Unique ID: 0255562 Medline TA: N Engl J Med Country: United States |
Other Details:
|
Languages: eng Pagination: 1393-403 Citation Subset: AIM; IM |
Affiliation:
|
Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA. harold.litt@uphs.upenn.edu |
| Data Bank Information | |
Bank Name/Acc. No.:
|
ClinicalTrials.gov/NCT00933400 |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Acute Coronary Syndrome
/
mortality,
radiography* Adult Aged Confidence Intervals Coronary Angiography* / methods Coronary Disease / diagnosis, radiography*, therapy Female Health Resources / utilization Hospitalization Humans Length of Stay Male Middle Aged Myocardial Infarction / epidemiology Patient Discharge Tomography, X-Ray Computed |
| Comments/Corrections | |
Comment In:
|
N Engl J Med. 2012 Jul 5;367(1):83; author reply 85-6
[PMID:
22762327
]
N Engl J Med. 2012 Jul 5;367(1):84-5; author reply 85-6 [PMID: 22762330 ] N Engl J Med. 2012 Jul 5;367(1):84; author reply 85-6 [PMID: 22762329 ] N Engl J Med. 2012 Jul 5;367(1):85; author reply 85-6 [PMID: 22762331 ] N Engl J Med. 2012 Jul 5;367(1):83-4; author reply 85-6 [PMID: 22762328 ] N Engl J Med. 2012 Jul 26;367(4):375-6 [PMID: 22830468 ] Curr Cardiol Rep. 2012 Oct;14(5):537-9 [PMID: 22890753 ] Diagn Interv Imaging. 2012 Nov;93(11):811-2 [PMID: 23146826 ] Am Fam Physician. 2012 Nov 15;86(10):900-4 [PMID: 23157143 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Current Status of Off-Pump Coronary-Artery Bypass.
Next Document: Off-pump or on-pump coronary-artery bypass grafting at 30 days.