Triple rule-out computed tomography for risk stratification of patients with acute chest pain.

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  • Additional Information
    • Source:
      Publisher: Elsevier Country of Publication: United States NLM ID: 101308347 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1876-861X (Electronic) Linking ISSN: 1876861X NLM ISO Abbreviation: J Cardiovasc Comput Tomogr Subsets: MEDLINE
    • Publication Information:
      Original Publication: Cambridge, MA : Elsevier
    • Subject Terms:
      Multidetector Computed Tomography*; Angina Pectoris/*diagnostic imaging ; Cardiovascular Diseases/*diagnostic imaging ; Triage/*methods; Aged ; Angina Pectoris/etiology ; Angina Pectoris/mortality ; Angina Pectoris/therapy ; Cardiology Service, Hospital ; Cardiovascular Diseases/complications ; Cardiovascular Diseases/mortality ; Cardiovascular Diseases/therapy ; Emergency Service, Hospital ; Female ; Humans ; Length of Stay ; Male ; Middle Aged ; Patient Admission ; Predictive Value of Tests ; Prognosis ; Registries ; Reproducibility of Results ; Republic of Korea ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; Time Factors
    • Abstract:
      Aims: Clinical evidence supporting triple rule-out computed tomography (TRO-CT) for rapid screening of cardiovascular disease is limited. We investigated the clinical value of TRO-CT in patients with acute chest pain.
      Methods: We retrospectively enrolled 1024 patients who visited the emergency department (ED) with acute chest pain and underwent TRO-CT using a 128-slice CT system. TRO-CT was classified as "positive" if it revealed clinically significant cardiovascular disease including obstructive coronary artery disease, pulmonary thromboembolism, or acute aortic syndrome. The clinical endpoint was occurrence of a major adverse cardiovascular event (MACE) within 30 days, defined by a composite of all cause death, myocardial infarction, revascularization, major cardiovascular surgery, or thrombolytic therapy. Clinical risk scores for acute chest pain including TIMI, GRACE, Diamond-Forrester, and HEART were determined and compared to the TRO-CT findings.
      Results: TRO-CT revealed clinically significant cardiovascular disease in 239 patients (23.3%). MACE occurred in 119 patients (49.8%) with positive TRO-CT and in 7 patients (0.9%) with negative TRO-CT (p < 0.001). Sensitivity, specificity, positive predictive value, and negative predictive value of TRO-CT was 95%, 88%, 54%, and 99%, respectively. TRO-CT was a better discriminator between patients with vs. without events as compared to clinical risk scores (c-statistics = 0.91 versus 0.64 to 0.71; integrated discrimination improvement = 0.31 to 0.37; p < 0.001 for all comparisons). Patients with a negative TRO-CT showed shorter ED stay times and admission rates compared to patients with positive TRO-CT, irrespective of clinical risk scores (p < 0.001 for all comparisons).
      Conclusion: Triple rule-out CT has high predictive performance for 30-day MACE and permits rapid triage and low admission rates irrespective of clinical risk scores.
      (Copyright © 2016 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.)
    • Contributed Indexing:
      Keywords: Acute cardiac care; Chest pain; Triple rule-out computed tomography
    • Publication Date:
      Date Created: 20160705 Date Completed: 20170612 Latest Revision: 20170612
    • Publication Date:
      20240829
    • Accession Number:
      10.1016/j.jcct.2016.06.002
    • Accession Number:
      27375202