Ethan J. Halpern MD, Presenter: Research grant, Koninklijke Philips Electronics NV Research grant, Lantheus Medical Imaging, Inc Equipment support, Toshiba Corporation

Carmine Alexander Grieco MD, Abstract Co-Author: Nothing to Disclose

Kevin M. Takakuwa MD, Abstract Co-Author: Nothing to Disclose

Kenneth J Neuburger MD, Abstract Co-Author: Nothing to Disclose

To evaluate follow-up imaging and outcomes of emergency department (ED) patients presenting with chest pain and triaged with triple rule-out coronary CT angiography (TRO-cCTA).

TRO-cCTA was performed on 135 consecutive chest pain patients judged to be at low-to-moderate risk for acute coronary syndrome (ACS).  ECG-gated studies were performed with a 256 slice iCT scanner (Philips Medical Systems) during infusion of 95cc of intravenous contrast material. A “triple rule-out” protocol was used to evaluate for coronary disease, pulmonary embolism, aortic dissection and other thoracic pathology.  Follow-up imaging studies and 30-day clinical follow-up were obtained on all subjects.

The patient population included 75 females and 60 males with a mean age of 51±11.5 years.  TRO-cCTA demonstrated 79 patients with normal coronary arteries, 40 patients with minimal CAD (<30% stenosis), 11 patients with mild to moderate CAD (30-70% stenosis) and 5 patients with severe CAD.  Two patients were found to have an anomalous right coronary artery with an interarterial course, and one patient was found with an anomalous circumflex artery. One patient was identified with acute pulmonary embolism and one with an aortic aneurysm. Follow-up imaging was requested in a minority of patients: stress testing in 6 patients, echocardiography in 18 patients and stress testing + echocardiography in 6 patients.  Of 7 patients who were sent for cardiac catheterization, 4 were found to have severe CAD (>70% stenosis), while the remaining 3 had only mild disease.  Of the 4 patients with severe CAD, 3 were identified as severe on cCTA, while one was identified as mild-moderate calcified plaque. The remaining patients were discharged without additional imaging studies.  No adverse cardiovascular or pulmonary outcomes were identified on 30 day follow-up.

TRO-cCTA evaluation of chest pain patients provides a rapid evaluation that allowed safe discharge for over 75% of low-risk chest pain patients without further imaging evaluation and with no adverse outcomes at 30-day follow-up.

“Triple rule-out” cCTA may be used to rapidly evaluate and safely discharge low-to-moderate risk ACS patients presenting to the ED.

Halpern, E, Grieco, C, Takakuwa, K, Neuburger, K, Evaluation of Acute Chest Pain in the Emergency Department: Effectiveness of Triple Rule-Out CT Angiography for Triage of Patients.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11005424.html