Comparison Between Anatomical and Functional Imaging Modalities for Evaluation of Chest Pain in the Emergency Department

Faraj Kargoli, Jeffrey Levsky, Nurilign Bulcha, Mohammad Hashim Mustehsan, Durline Brown-Manhertz, Andrea Furlani, Dalvert Polanco, Sarah Mizrachi, Mohammed Makkiya, Anjani Golive, Linda Haramati, Cynthia Taub, Mario J. Garcia

Research output: Contribution to journalArticle

Abstract

Evaluation of chest pain in the emergency department (ED) frequently employs a noninvasive strategy, including coronary computed tomography angiography (CCTA), stress echocardiography (SE), or myocardial perfusion imaging (MPI). We sought to report the real-world experience of utilizing CCTA compared with SE and MPI at an urban hospital ED. We conducted a retrospective cohort study of consecutively enrolled patients presenting with chest pain who had normal or nondiagnostic electrocardiogram (ECG), negative initial troponin-T, at least intermediate risk based on modified Diamond-Forrester criteria, and who underwent CCTA, SE, or MPI based on their individual test eligibility criteria. The primary outcome was ED discharge time. Secondary outcomes included test utilization and 30-days rehospitalization rates. The 2,143 patients who were included (mean age was 56 ± 12 years; 55% women) utilization rate (test performed/eligible) was lower for CCTA (n = 354/1,329) and MPI (n = 530/1,435) compared with SE (n = 1,259/1,650), p <0.001. Mean ED discharge times for both CCTA and SE were 12.5 ± 7.4 versus 16 ± 7.3 hours for MPI (p <0.0001). Patients with SE and CCTA were less likely to undergo coronary angiography (29%, 25%, vs 52% for MPI). There was a 1% cardiac-related 30-days rehospitalization rate in the CCTA group versus 1% in SE and 3% in the MPI group (p <0.01). In conclusion, CCTA and SE were associated with faster ED discharge and lower frequency of diagnostic coronary angiography. Notwithstanding its clinical utility, CCTA was underutilized at our large urban ED setting.

Original languageEnglish (US)
Pages (from-to)1809-1814
Number of pages6
JournalAmerican Journal of Cardiology
Volume125
Issue number12
DOIs
StatePublished - Jun 15 2020

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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