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Secondary cardiac risk stratifying tests after coronary computed tomography angiography in emergency department patients.
- Source :
-
Journal of cardiovascular computed tomography [J Cardiovasc Comput Tomogr] 2018 Nov - Dec; Vol. 12 (6), pp. 500-508. Date of Electronic Publication: 2018 Oct 11. - Publication Year :
- 2018
-
Abstract
- Background: Several large trials demonstrated that coronary computed tomography angiography (CTA) in a triage strategy could lead to increased secondary cardiac risk stratifying testing (SCRST). Whether this is true for routine clinical care remains unclear. We measured SCRSTs after coronary CTA was implemented in our emergency department (ED) practice by CTA result, and if locally existing management recommendations for a structured post CTA diagnostic strategy were followed.<br />Methods: This single site retrospective cohort study included all our ED patients who received coronary CTA between October 1, 2012 and September 30, 2016. SCRST's included functional cardiac tests and invasive coronary angiography (ICA), performed during the ED coronary CTA visit or related admission.<br />Results: A total of 1916 subjects were included with a mean age of 52.9 ± 10.8 years. Of their coronary CTAs, 179 were positive (severe stenosis, occlusion or ventricular wall motion abnormalities; 9.3%), 105 intermediate (moderate stenosis; 5.5%), 1611 negative (no to mild obstructive CAD; 84.1%) and 21 non-diagnostic (1.1%). SCRSTs were performed in 237 (overall 12.4%, noninvasive in 5.6%, ICA in 6.7%). After positive coronary CTA, 73.7% of subjects received SCRSTs. For intermediate, negative and non-diagnostic CTAs this was 72.4%, 1.1% and 47.6% respectively. Management conformed to local management recommendations in 96.2% of cases.<br />Conclusion: In spite of previous trials, rates of secondary cardiac risk stratifying tests after routine clinical ED coronary CTA are low, especially in patients with negative coronary CTA. Structured management guidelines for post coronary CTA, and adherence to these guidelines, appear essential.<br /> (Copyright © 2018. Published by Elsevier Inc.)
- Subjects :
- Adolescent
Adult
Aged
Aged, 80 and over
Boston
Coronary Angiography standards
Coronary Artery Disease therapy
Coronary Stenosis therapy
Female
Guideline Adherence
Humans
Male
Middle Aged
Practice Guidelines as Topic
Predictive Value of Tests
Prognosis
Registries
Retrospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Triage
Young Adult
Computed Tomography Angiography standards
Coronary Angiography methods
Coronary Artery Disease diagnostic imaging
Coronary Stenosis diagnostic imaging
Coronary Vessels diagnostic imaging
Emergency Service, Hospital standards
Subjects
Details
- Language :
- English
- ISSN :
- 1876-861X
- Volume :
- 12
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Journal of cardiovascular computed tomography
- Publication Type :
- Academic Journal
- Accession number :
- 30340962
- Full Text :
- https://doi.org/10.1016/j.jcct.2018.10.005