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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Thursday, September 22, 2016

Coronary CTA Use

emDocs - September 20, 2016 - Authors: Long B and Koyfman A - Edited by: Santistevan J 
"This is the second of a two-part series evaluating chest pain controversies in the ED. The American Heart Association (AHA) supports noninvasive cardiac imaging for further evaluation before or within 72 hours of discharge, which may consist of stress testing, CCTA, or no further testing at all. As discussed previously, a nonischemic ECG with negative cardiac biomarkers at 0 hr and 3 hr is associated with low risk of major cardiac adverse event (MACE). This post will examine the use of CCTA in the ED. Are there benefits? What are the adverse effects? 
  • Missed ACS is a concern for patients and emergency providers. Nonischemic ECG and negative biomarker at 0 and 3 hours reduces risk of MACE to less than 1%.
  • Stress testing and CCTA are commonly used for further evaluation of these patients, but their ability to further risk stratify low risk patients further is controversial.
  • Use of CCTA has increased, with the goal to evaluate anatomical coronary artery disease.
  • CCTA is associated with decreased ED LOS. However, CCTA is also associated with further downstream testing, with no evidence of improved outcome in low risk patients.
  • Intermediate risk patients, or those with difficulty obtaining follow up, may benefit from CCTA, though further studies are required in this patient subset."