Non-invasive assessment of low risk acute chest pain in the emergency department: A comparative meta-analysis of prospective studies

Romero, Jorge; Husain, Syed Arman; Holmes, Anthony A.; Kelesidis, Iosif; Chavez, Patricia; Mojadidi, Mohammad K.; Levsky, Jeffrey M.; Wever-Pinzon, Omar; Taub, Cynthia C.; Makani, Harikrishna; Travin, Mark I.; Piña, Ileana L.; García, Mario J.

doi:10.1016/j.ijcard.2015.01.032

Cited by 25 publications

(17 citation statements)

References 60 publications

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“…The 10‐year follow‐up from the WISE study demonstrated a 20% mortality rate in women referred for invasive angiography for symptoms of ischemia. In those who did not have obstructive disease, the 10‐year mortality was 13%, significantly greater than asymptomatic age‐matched controls (2.8%) …”

Section: Cardiomyopathiesmentioning

confidence: 84%

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Sex differences in heart failure

Eisenberg

Palo

Piña

2018

Clinical Cardiology

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101

113

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Heart failure (HF) numbers continue to grow in the United States and approximately 50% of patients living with HF are women. For the provider, it is critical to understand the role that gender plays in recognition, diagnosis, and management. The purpose of this literature review is to highlight the prevalence of heart failure in women and discuss gender variations in epidemiology, symptoms, pharmacology, and treatment as well as examine the representation of women in clinical trials.

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Section: Cardiomyopathiesmentioning

confidence: 84%

“…Patients with HFpEF will uniformly have a LVEF >40%, but many will have echocardiographic evidence of diastolic dysfunction, elevated filling pressures, and pulmonary HTN. In the patient with exertional symptoms and normal filling pressures at rest, diastolic stress testing can be utilized …”

Section: Heart Failure With Preserved Ejection Fractionmentioning

confidence: 99%

Sex differences in heart failure

Eisenberg

Palo

Piña

2018

Clinical Cardiology

Self Cite

101

113

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“…73 According to a recent meta-analysis of prospective studies published in 2015 comparing the diagnostic accuracy of coronary cardiac CT with functional imaging modalities (n 5 7800) for the assessment of ACP in ED setting, cardiac CT performed better that stress echo and SPECT in predicting significant CAD at invasive coronary angiography or the later presence of major adverse clinical outcomes. 74 Cardiac CT demonstrated a pool sensitivity of 95%, specificity of 99%, PPV of 84% and NPV of 99%. 74 Randomized controlled trials evaluating the effectiveness of cardiac CT in the emergency department At present, five randomized controlled trials (RCTs) have evaluated the safety and economic impact of cardiac CT compared with the usual care for patients presenting to the ED with suspicion of ACS ( Table 5).…”

Section: Cardiac Ctmentioning

confidence: 94%

“…74 Cardiac CT demonstrated a pool sensitivity of 95%, specificity of 99%, PPV of 84% and NPV of 99%. 74 Randomized controlled trials evaluating the effectiveness of cardiac CT in the emergency department At present, five randomized controlled trials (RCTs) have evaluated the safety and economic impact of cardiac CT compared with the usual care for patients presenting to the ED with suspicion of ACS ( Table 5). The first of these by Goldstein et al 75 published in 2007 became the basis for the subsequent multicentre CT-STAT (coronary CT angiography for systematic triage of patients with acute chest pain to treatment) trial, 76 comparing cardiac CT with SPECT.…”

Section: Cardiac Ctmentioning

confidence: 94%

Chest pain: coronary CT in the ER

Maffei¹,

Seitun²,

Guaricci³

et al. 2016

BJR

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Cardiac CT has developed into a robust clinical tool during the past 15 years. Of the fields in which the potential of cardiac CT has raised more interest is chest pain in acute settings. In fact, the possibility to exclude with high reliability obstructive coronary artery disease (CAD) in patients at low-to-intermediate risk is of great interest both from the clinical standpoint and from the management standpoint. Several other modalities, with or without imaging, have been used during the past decades in the settings of new onset chest pain or in acute chest pain for both diagnostic and prognostic assessment of CAD. Each one has advantages and disadvantages. Most imaging modalities also focus on inducible ischaemia to guide referral to invasive coronary angiography. The advent of cardiac CT has introduced a new practice diagnostic paradigm, being the most accurate non-invasive method for identification and exclusion of CAD. Furthermore, the detection of subclinical CAD and plaque imaging offer the opportunity to improve risk stratification. Moreover, recent advances of the latest generation CT scanners allow combining both anatomical and functional imaging by stress myocardial perfusion. The role of cardiac CT in acute settings is already important and will become progressively more important in the coming years.

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“…larization following anatomical testing, as well as the potential missed diagnosis by functional testing. More important, the comparative effectiveness of CCTA vs usual care needs to be assessed in randomized trials in which the initial choice of noninvasive testing determines the treatment plans.Previous meta-analysis reported potential benefits of CCTA in patients with stable chest pain 7 or those with acute chest pain 32. Although these studies provided valuable findings about the use of CCTA,7,8,32 their results should be interpreted cautiously because these studies included short-term follow-up RCTs, such as a study by Min et al with 2 months of follow-up,3 the original publication of the ACRIN-PA trial that reported outcomes of 1 month of follow-up,14 …”

mentioning

confidence: 99%