Brian Burns Ghoshhajra MD, Presenter: Nothing to Disclose

Harshna Vinodbhai Vadvala MD, Abstract Co-Author: Nothing to Disclose

Phillip Kim, Abstract Co-Author: Nothing to Disclose

Thomas Mayrhofer, Abstract Co-Author: Nothing to Disclose

Quynh Truong MD, Abstract Co-Author: Research Grant, St. Jude Medical, Inc

Suhny Abbara MD, Abstract Co-Author: Research Consultant, Radiology Consulting Group

Mannudeep K. S. Kalra MD, Abstract Co-Author: Nothing to Disclose

Rajiv Gupta PhD, MD, Abstract Co-Author: Nothing to Disclose

Garry Choy MD, MS, Abstract Co-Author: Nothing to Disclose

Sanjeev Francis MD, Abstract Co-Author: Nothing to Disclose

David Brown, Abstract Co-Author: Nothing to Disclose

John T. Nagurney, Abstract Co-Author: Nothing to Disclose

Robert A. Novelline MD, Abstract Co-Author: Nothing to Disclose

Laura Louise Avery MD, Abstract Co-Author: Nothing to Disclose

James Januzzi, Abstract Co-Author: Nothing to Disclose

Jeffrey Greenwald, Abstract Co-Author: Nothing to Disclose

Udo Hoffmann MD, Abstract Co-Author: Nothing to Disclose

Recent randomized controlled trials have established coronary CT angiography (CCTA) as an alternative in evaluating low- to intermediate risk ED patients with acute chest pain. We report our initial clinical experience in the MGH registry and compared quality metrics with the ROMICAT (Rule Out Myocardial Infarction with Computer Assisted Tomography) II (R-II) results.

We included patients that presented to the ED with acute chest pain and were referred for CCTA to rule out significant coronary artery disease between October 2012 and December 2013. We prospectively recorded patient demographics, risk factors, and clinical presentation, radiation dose, CCTA results, disposition, time to report, additional diagnostic testing, interventions. Medical records were reviewed at 60 days after discharge. Results were compared with the multicenter, randomized, controlled R-II trial.

227 patients were included (54.2% male, mean age 51.2 ± 10.6). Per CCTA 57% had no CAD (n=130), 27% had mild CAD (n=62), 5.7 % had moderate CAD (n=13), 7.9% had severe CAD (n=18), 1% had occlusive disease (n=3), and 0.4% had an inconclusive exam (n=1). Mean length of hospital stay and time to diagnosis were shorter but not significantly different as compared to R-II (21.3 ± 46.6 hours vs. 23.2 ± 37 hours; p=.59 and 9.6 ± 9.7 hours vs. 10.4 ± 12.6 hours; p=.35, respectively). Median time from CCTA to report was 54 minutes. When compared to the R-II trial, estimated effective dose (mean, mSv) was significantly lower (4.3 ± 2.8 mSv vs. 6.2 ± 3.8 mSv; p<.01) respectively, primarily achieved via more frequent prospective ECG triggering (89% vs.13%, p<.01). Invasive coronary angiography (ICA) was performed in 8%(n=18) vs.11% (n=54), nuclear myocardial perfusion imaging in 11% (n=26) vs. 10% (n=50), and exercise tolerance test in 2%(n=4) vs. 2%(n=12) patients in registry versus R-II, respectively. Importantly, the normalcy rate for ICA was lower than as compared to R-II (6% vs 20%), while no missed ACS were reported at 60 days.

Real world clinical data of early CCTA in the management of patients with acute chest pain confirm the results of the ROMICAT II trial with further reduction in radiation dose.

Implementation of prospective CCTA protocols and strict quality metrics enabled significant reduction of radiation exposure and reduced normal ICA after CCTA while maintaining a 100% negative predictive value.  

Ghoshhajra, B, Vadvala, H, Kim, P, Mayrhofer, T, Truong, Q, Abbara, S, Kalra, M, Gupta, R, Choy, G, Francis, S, Brown, D, Nagurney, J, Novelline, R, Avery, L, Januzzi, J, Greenwald, J, Hoffmann, U, Clinical Implementation of an Acute Chest Pain Coronary CTA Registry ED Protocol on the Heels of the ROMICAT Trials—The ED CCTA Registry at a Tertiary Medical Center.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14018452.html