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Home » Imaging News » February 7, 2007

Emergency Room Cardiac CT Used to
Rule Out Coronary Artery Disease

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Multislice CT Angiogram
-- Angioplasty.Org

Heart Attack and Angioplasty
-- Angioplasty.Org

February 7, 2007 -- A study published in the current issue of "Academic Emergency Medicine" finds that Cardiac CT (also called CT Angiography or Multislice CT) can be used in the Emergency Room to quickly rule out heart problems in low-risk patients who come in with chest pain.

Normally, when a patient arrives at the ER with chest pains, various quick tests are done, EKGs, enzyme levels, etc. to determine if the patient is experiencing a heart attack (myocardial infarction). If it is a heart attack, then an immediate course of action is undertaken to stop the heart attack from progressing and to save the heart muscle. (Angioplasty, if available, is the preferred treatment -- see Angioplasty.Org's feature on "Heart Attack and Angioplasty")

But if the EKG and other tests are normal, and the patient continues to have chest pains, the course is less clear to the ER doctor. If the patient's pain is angina, which is caused by ischemia or lack of blood to the heart muscle, then the best course might be to admit the patient to the hospital for further testing. But if the pain is not cardiac-related, the patient could be sent home safely

A new tool that has been shown to rapidly determine the absence of coronary narrowing is the multislice CT scanner. The Emergency Department of the Hospital of the University of Pennsylvania in Philadelphia conducted a study in which low risk patients with normal EKGs were given a CT scan for evaluation. The study was small in size, but of 54 patients, 46 were judged to have no narrowing or atherosclerosis in their coronary arteries, and they were discharged. 8 patients were found to have varying degrees of atherosclerosis. They were studied further and cardiac catheterization confirmed the CT findings. No patients suffered any adverse events within 30 days of presenting in the Emergency Room.

The study team, headed by Dr. Judd E. Hollande, concluded:

"When used in the clinical setting for the evaluation of ED patients with low-risk chest pain, CT coronary angiography may safely allow rapid discharge of patients with negative studies. Further study to conclusively determine the safety and cost effectiveness of this approach is warranted."


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