{"id":27558,"date":"2012-03-26T09:04:30","date_gmt":"2012-03-26T13:04:30","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=news&#038;p=27558"},"modified":"2012-03-26T09:04:30","modified_gmt":"2012-03-26T13:04:30","slug":"ct-angiography-to-rule-out-cad-in-chest-pain-patients","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2012\/03\/26\/ct-angiography-to-rule-out-cad-in-chest-pain-patients\/","title":{"rendered":"CT Angiography to Rule Out CAD in Chest-Pain Patients"},"content":{"rendered":"<p>Each year, 6 million people in the U.S. arrive at the emergency department (ED) with acute chest pain. Although only 10% to 15% of them turn out to have an acute coronary syndrome (ACS), most are admitted to the hospital.\u00a0Coronary CT angiography (CCTA) has been proposed as a good method to quickly establish the presence or absence of coronary disease and to allow many of these patients to return home sooner.<\/p>\n<p>In <a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1201163?query=featured_home\">a presentation at the ACC and in a simultaneous publication in the\u00a0<em>New England Journal of Medicine<\/em><\/a>, the ACRIN (American College of Radiology Imaging Network) investigators report the findings of ACRIN PA 4005, the largest trial to date of the strategy to use CCTA to allow for more-rapid ruling out of coronary disease in patients with possible acute coronary syndrome.\u00a0Investigators randomized 1370 patients with chest pain, in a 2:1 ratio, to either CCTA or conventional care.<\/p>\n<p>The primary outcome was the safety at 30 days of patients with a negative CCTA. Among the 640 patients who had a negative CCTA examination, there were no MIs or cardiac deaths within 30 days.<\/p>\n<p>The investigators also observed that,\u00a0compared with controls, patients in the CCTA group were more likely to be discharged from the emergency department (49.6% vs. 22.7%) and had a shorter median length of stay (18.0 hours vs. 24.8 hours). Coronary disease was also more likely to be detected in the CCTA group (9.0% versus 3.5%).\u00a0Utilization of healthcare resources was similar in both groups.<\/p>\n<p>The major drawback to CCTA is radiation, but ACRIN investigator Harold Litt pointed out that\u00a0the radiation dose received by patients for CCTA is now lower than the dose received during nuclear imaging studies. &#8220;We believe that a CCTA-based strategy can safely and efficiently redirect many patients home who would otherwise be admitted,&#8221; the authors concluded.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Each year, 6 million people in the U.S. arrive at the emergency department (ED) with acute chest pain. Although only 10% to 15% of them turn out to have an acute coronary syndrome (ACS), most are admitted to the hospital.\u00a0Coronary CT angiography (CCTA) has been proposed as a good method to quickly establish the presence [&hellip;]<\/p>\n","protected":false},"author":196,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11],"tags":[1190,503,617],"class_list":["post-27558","post","type-post","status-publish","format-standard","hentry","category-cardiac-imaging","tag-coronary-ct-angiography","tag-ct-angiography","tag-cta"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/27558","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=27558"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/27558\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=27558"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=27558"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=27558"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}