2012
DOI: 10.1056/nejmoa1201161
|View full text |Cite
|
Sign up to set email alerts
|

Coronary CT Angiography versus Standard Evaluation in Acute Chest Pain

Abstract: Background It is unclear whether an evaluation incorporating coronary computed tomographic angiography (CCTA) is more effective than standard evaluation in the emergency department in patients with symptoms suggestive of acute coronary syndromes. Methods In this multicenter trial, we randomly assigned patients 40 to 74 years of age with symptoms suggestive of acute coronary syndromes but without ischemic electrocardiographic changes or an initial positive troponin test to early CCTA or to standard evaluation… Show more

Help me understand this report

Search citation statements

Order By: Relevance

Paper Sections

Select...
3
2

Citation Types

11
508
4
12

Year Published

2012
2012
2019
2019

Publication Types

Select...
8

Relationship

0
8

Authors

Journals

citations
Cited by 787 publications
(535 citation statements)
references
References 18 publications
(21 reference statements)
11
508
4
12
Order By: Relevance
“…14,16,17 The current study confirmed the significant time savings of CTA in efficiently triaging patients. In the ACRIN PA 4005 and ROMICAT-II studies, direct discharge from the ED was more common in the CTA group although the use of observation units clouds the picture to some extent as ''admission to the hospital'' in ROMICAT-II was reduced only modestly with 25.4% vs 31.7%.…”
Section: Discussionsupporting
confidence: 76%
See 1 more Smart Citation
“…14,16,17 The current study confirmed the significant time savings of CTA in efficiently triaging patients. In the ACRIN PA 4005 and ROMICAT-II studies, direct discharge from the ED was more common in the CTA group although the use of observation units clouds the picture to some extent as ''admission to the hospital'' in ROMICAT-II was reduced only modestly with 25.4% vs 31.7%.…”
Section: Discussionsupporting
confidence: 76%
“…[11][12][13] Several recent randomized studies and two metaanalyses have been published examining the diagnostic utility of CTA in evaluating patients in the ED with possible ACS. [14][15][16][17][18][19] Recent CTA studies have suggested efficient triage of patients, safe expedited discharge from the ED, cost effectiveness, and lower radiation dose when compared to standard diagnostic evaluation including MPI. However, this comparison has been to older conventional Na-I SPECT cameras using traditional rest-stress protocols.…”
Section: Introductionmentioning
confidence: 99%
“…As noted in the introduction, randomized trials have demonstrated excellent negative predictive value for cCTA in evaluation of patients presenting to the ED with chest pain, and have suggested that cCTA may be more cost-effective than traditional stress testing for rapid discharge of these ED chest pain patients. [14][15][16][17][18] Another significant advantage of cCTA over stress testing is the ability to assess simultaneously for non-cardiac etiologies of chest pain in the mediastinum, lungs and chest wall. In appropriate clinical situations where both cardiac and noncardiac vascular causes of chest pain are suspected, a "triple rule-out" CTA study can evaluate the aorta, coronary arteries and pulmonary arteries and expedite discharge of up to 75% of patients presenting to the ED with atypical chest pain.…”
Section: Discussionmentioning
confidence: 99%
“…14,15 Three randomized multicenter trials have recently confirmed cCTA as a safe and cost-effective diagnostic test to discharge low-risk chest pain patients. 16,17,18 These randomized multicenter studies have opened the possibility of widespread cCTA testing for low risk ED patients presenting with chest pain, though the utility of such testing depends upon the pre-test probability of disease. 19 Many practicing physicians remain convinced that accurate evaluation of traditional risk factors and clinical presentation can be used for triage of the low risk ED patient and to limit the number of ED patients who should be referred for cCTA.…”
Section: Introductionmentioning
confidence: 99%
“…In the setting of suspected stable CAD, large multicenter trials such as the PROMISE (4) and SCOT-HEART (5) have demonstrated that CCTA is clinically useful as an alternative or in addition to functional testing. In the triage of patients with acute chest pain, also large trials such as CT-STAT (6), ACRIN-PA (7), ROMICAT II (8), CT-COMPARE (9) and real world scenario (10,11) in where CCTA was rivaled with standard of care, have demonstrated that negative CT findings allowed to safety rule out CAD and identify patients eligible for early discharge from the emergency department.…”
Section: Introductionmentioning
confidence: 99%