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Triple rule-out computed tomography for risk stratification of patients with acute chest pain

2016; Elsevier BV; Volume: 10; Issue: 4 Linguagem: Inglês

10.1016/j.jcct.2016.06.002

1934-5925

Minjung Kathy Chae, Eun Kyoung Kim, Ka-Young Jung, Tae Gun Shin, Min Seob Sim, Ik-Joon Jo, Keun Jeong Song, Sung‐A Chang, Young Bin Song, Joo‐Yong Hahn, Seung‐Hyuk Choi, Hyeon‐Cheol Gwon, Sanghoon Lee, Sung Mok Kim, Hong Eo, Yeon Hyeon Choe, Jin‐Ho Choi,

Ultrasound in Clinical Applications

Aims 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. Methods 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. Results 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). Conclusion 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.