Trends in utilization of Coronary CT Angiography in patients presenting with acute chest pain in United States: An analysis of the National Emergency Database

Shaikh, Kashif; Walters, Ryan W.; Aboeata, Ahmed; Thandra, Abhishek; Anugula, Dixitha; Urja, Prakrity; Budoff, Matthew J.; Alla, Venkata

doi:10.1016/j.jcct.2021.11.006

Cited by 3 publications

(3 citation statements)

References 8 publications

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“…21,22 Our study also revealed that few (n=65) individuals with acute ischemic stroke underwent CCTA to assess their coronary arteries, and all of them belonged to the group without STEMI. Shaikh et al 23 also reported underutilization of CCTA in patients who presented to the emergency department with chest pain although it was found to reduce the length of stay for the patients with acute chest pain. 24 Additionally, we saw that just 0.16% of patients in the group with STEMI had undergone a cardiac stress test before discharge.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Outcomes of Patients With Acute Ischemic Stroke With Concomitant ST-Segment–Elevation Myocardial Infarction (Results From National Inpatient Sample 2016–2019)

Mehta,

Kakouros,

Mir

et al. 2024

Stroke

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BACKGROUND: Acute myocardial infarction may concomitantly occur with acute ischemic stroke. The prevalence, complications, and outcomes of acute ST-segment–elevation myocardial infarction (STEMI) in patients hospitalized with acute ischemic stroke are not well studied. METHODS: We examined hospitalized patients with acute ischemic stroke who were included in the National Inpatient Sample from 2016 to 2019. Acute ischemic stroke and STEMI were defined by using the International Classification of Diseases-Tenth Revision diagnostic codes. Patients with Non–STEMI were excluded. The prevalence of complications and outcomes were expressed as percentages. Multivariable logistic regression analysis was used to examine the association of STEMI with a primary outcome of mortality and secondary outcomes. A subgroup analysis of patients with STEMI who underwent percutaneous coronary intervention was also performed. RESULTS: Of the total (n=2 080 795) patients with acute ischemic stroke, 0.3% (n=6275; mean age, 70.5 years, 50.1% females, 69.5% White) also had STEMI diagnosed during the hospitalization. Of these, 1775 (28.3%) died in the STEMI group and 76 435 (3.7%) died in the group without STEMI. The most frequent complications in the STEMI group were acute kidney injury, intracranial hemorrhage, and ventricular arrhythmias. All secondary outcomes were associated with the diagnosis of STEMI (odds ratio [OR], 3.19 [95% CI, 2.82–3.6]; P ≤0.001). STEMI was associated with mortality (OR, 8.37 [95% CI, 7.25–9.66]; P ≤0.001) and intracranial hemorrhage (OR, 2.23 [95% CI, 1.84–2.70]; P ≤0.001). Percutaneous coronary intervention was performed in 14.3% of STEMI subgroup patients. Percutaneous coronary intervention is not associated with mortality (OR, 0.93 [95% CI, 0.6–1.43]; P =0.7), and intracranial hemorrhage (OR, 1.54 [95% CI, 0.0.93–2.56]; P =0.1). CONCLUSIONS: Patients with acute ischemic stroke with STEMI have a higher percentage of mortality. Percutaneous coronary intervention in the subgroup of patients with acute ischemic stroke with concomitant STEMI was not associated with increased odds of mortality and intracranial hemorrhage.

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Section: Discussionmentioning

confidence: 99%

Prevalence and Outcomes of Patients With Acute Ischemic Stroke With Concomitant ST-Segment–Elevation Myocardial Infarction (Results From National Inpatient Sample 2016–2019)

Mehta,

Kakouros,

Mir

et al. 2024

Stroke

View full text Add to dashboard Cite

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“…Coronary CTA is primarily requested by cardiologists in Canada. [20][21][22] Without targeted educational efforts on relatively newer cardiac imaging modalities and their appropriate use in clinical practice, many PCPs bear the burden of trying to interpret and understand the strengths and limitations of these complex tests, which may inadvertently expose patients to unnecessary testing and delayed diagnoses. 22 This study aimed to characterize trends in the first-line cardiac investigations requested by PCPs at Women's College Hospital (WCH) between 2017 and 2019, following a series of educational sessions (targeting PCPs and presented by cardiothoracic radiologists) regarding the merits of using coronary CTA as the first-line test to investigate stable chest pain in intermediate-or high-risk patients.…”

Section: Introductionmentioning

confidence: 99%

“…Coronary CTA is primarily requested by cardiologists in Canada. 20-22 Without targeted educational efforts on relatively newer cardiac imaging modalities and their appropriate use in clinical practice, many PCPs bear the burden of trying to interpret and understand the strengths and limitations of these complex tests, which may inadvertently expose patients to unnecessary testing and delayed diagnoses. 22…”

Section: Introductionmentioning

confidence: 99%

Cardiac Investigation Trends Among Primary Care Physicians: A Paradigm Shift

Afgani

Brenna

et al. 2022

Can Assoc Radiol J

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Objective While numerous recent guidelines support coronary computed tomography angiography (CTA) as a first-line test for stable chest pain, it remains underutilized by primary care physicians (PCPs). We aimed to evaluate cardiac investigation ordering practices following education sessions, as well as the total number of downstream tests and time to diagnosis for patients presenting with stable chest pain. Methods A retrospective chart review was completed for eligible patients assessed at the Women's College Hospital Family Practice Health Centre between 2017 and 2019 following the education sessions. The outcome measures were first-choice cardiac investigation, additional downstream testing, time from presentation to first investigation, and time to final diagnosis. Results 419 patients were included in the final analysis (74.70% female; mean age 61 ± 11 years). Coronary CTA requests by PCPs increased between 2017 and 2019 (18 vs 72 tests; P < .0001). When coronary CTA was the first-line test, patients were less likely to receive additional downstream testing when compared to those receiving other first-line investigations ( P < .0001). Coronary CTA was associated with longer time to diagnosis than stress echocardiography (47 ± 45 vs 27 ± 36 days; P = .0068) due to limited availability of coronary CTA appointment times. There was no significant difference in time to final diagnosis among the cardiac imaging modalities observed in the cohort ( P = .0623). Conclusion Utilization of coronary CTA as the first-line test for stable chest pain increased following our education sessions targeting PCPs. Coronary CTA was associated with less downstream testing compared to other non-invasive cardiac investigations.

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National cost savings, operational and safety benefits from use of magnetocardiography in the assessment of emergency department chest pain patients

Baugh,

Pena,

Takla

et al. 2024

American Heart Journal Plus: Cardiology Research and Practice

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Trends in utilization of Coronary CT Angiography in patients presenting with acute chest pain in United States: An analysis of the National Emergency Database

Cited by 3 publications

References 8 publications

Prevalence and Outcomes of Patients With Acute Ischemic Stroke With Concomitant ST-Segment–Elevation Myocardial Infarction (Results From National Inpatient Sample 2016–2019)

Prevalence and Outcomes of Patients With Acute Ischemic Stroke With Concomitant ST-Segment–Elevation Myocardial Infarction (Results From National Inpatient Sample 2016–2019)

Cardiac Investigation Trends Among Primary Care Physicians: A Paradigm Shift

National cost savings, operational and safety benefits from use of magnetocardiography in the assessment of emergency department chest pain patients

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