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Triple rule-out computed tomography for risk stratification of patients with acute chest pain
- Source :
- Journal of cardiovascular computed tomography. 10(4)
- Publication Year :
- 2016
-
Abstract
- Clinical evidence supporting triple rule-out computed tomography (TRO-CT) for rapid screening of cardiovascular disease is limited. We investigated the clinical value of TRO-CT in patients with acute chest pain.We retrospectively enrolled 1024 patients who visited the emergency department (ED) with acute chest pain and underwent TRO-CT using a 128-slice CT system. TRO-CT was classified as "positive" if it revealed clinically significant cardiovascular disease including obstructive coronary artery disease, pulmonary thromboembolism, or acute aortic syndrome. The clinical endpoint was occurrence of a major adverse cardiovascular event (MACE) within 30 days, defined by a composite of all cause death, myocardial infarction, revascularization, major cardiovascular surgery, or thrombolytic therapy. Clinical risk scores for acute chest pain including TIMI, GRACE, Diamond-Forrester, and HEART were determined and compared to the TRO-CT findings.TRO-CT revealed clinically significant cardiovascular disease in 239 patients (23.3%). MACE occurred in 119 patients (49.8%) with positive TRO-CT and in 7 patients (0.9%) with negative TRO-CT (p 0.001). Sensitivity, specificity, positive predictive value, and negative predictive value of TRO-CT was 95%, 88%, 54%, and 99%, respectively. TRO-CT was a better discriminator between patients with vs. without events as compared to clinical risk scores (c-statistics = 0.91 versus 0.64 to 0.71; integrated discrimination improvement = 0.31 to 0.37; p 0.001 for all comparisons). Patients with a negative TRO-CT showed shorter ED stay times and admission rates compared to patients with positive TRO-CT, irrespective of clinical risk scores (p 0.001 for all comparisons).Triple rule-out CT has high predictive performance for 30-day MACE and permits rapid triage and low admission rates irrespective of clinical risk scores.
- Subjects :
- Male
medicine.medical_specialty
Time Factors
030204 cardiovascular system & hematology
Chest pain
Risk Assessment
Severity of Illness Index
Angina Pectoris
Coronary artery disease
03 medical and health sciences
0302 clinical medicine
Patient Admission
Predictive Value of Tests
Risk Factors
Internal medicine
Multidetector Computed Tomography
Republic of Korea
medicine
Clinical endpoint
Humans
Radiology, Nuclear Medicine and imaging
030212 general & internal medicine
Myocardial infarction
Registries
Aged
Retrospective Studies
Acute aortic syndrome
business.industry
Reproducibility of Results
Emergency department
Length of Stay
Middle Aged
medicine.disease
Prognosis
Cardiovascular Diseases
Cardiology
Female
Cardiology Service, Hospital
medicine.symptom
Triage
Cardiology and Cardiovascular Medicine
business
Emergency Service, Hospital
TIMI
Mace
Subjects
Details
- ISSN :
- 1876861X
- Volume :
- 10
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Journal of cardiovascular computed tomography
- Accession number :
- edsair.doi.dedup.....d5753e0e06b6437b40822f07c1cc16bb