Jones Ronald L, Thomas Dustin M, Barnwell Megan L, Fentanes Emilio, Young Adam N, Barnwell Robert, Foley Austin T, Hilliard Michael, Hulten Edward A, Villines Todd C, Cury Ricardo C, Slim Ahmad M
Cardiology Service, San Antonio Military Medical Center, 3551 Roger Brooke Drive, San Antonio, Texas 78234-6200, USA.
Emergency Department, San Antonio Military Medical Center, San Antonio, TX, USA.
J Cardiovasc Comput Tomogr. 2014 Sep-Oct;8(5):375-83. doi: 10.1016/j.jcct.2014.08.003. Epub 2014 Aug 19.
Coronary CT angiography (CTA) is a powerful tool for the evaluation of chest pain in the emergency department (ED). Some debate persists regarding its cost-effectiveness in a low-to-intermediate risk population.
This study sought to evaluate the safety and cost-effectiveness of coronary CTA for low-to-intermediate risk patients presenting to the ED with chest pain in a closed-loop referral system.
Chest pain patients were evaluated in the ED via a local rapid coronary CTA protocol and tracked prospectively for ED throughput, disposition, chest pain recidivism, and cost utilization as compared with an age-matched cohort evaluated for chest pain treated with usual care.
One hundred eighty-three patients underwent the rapid coronary CTA protocol compared with an age-matched cohort of 184 patients treated with usual care. The median follow-up period for major adverse cardiovascular events in the coronary CTA group was 9.0 months (range, 1.8-14.5 months) and 11.1 months (range, 0-14.0 months) for the age-matched cohort. The median ED length of stay (LOS) was 5.8 hours (range, 2.6-12.3 hours) for the rapid coronary CTA cohort and 12.2 hours (range, 1.7-40.3 hours) for the age-matched cohort (P < .001). The median time to performance of coronary CTA was 2.5 hours (range, 0.4-8.7 hours) with a median time from coronary CTA performance to disposition of 2.9 hours (range, 0.8-8.6 hours). Total median hospital LOS was 5.9 hours (range, 2.7-124 hours) in the rapid coronary CTA cohort compared with 25.0 hours (range, 1.2-208 hours) in the age-matched cohort (P < .001). Hospital admission was more common in the age-matched cohort (98.9% vs 9.3%; P < .001). There was a significant reduction in total payer cost in coronary CTA group when compared to usual care ($182,064.55 vs $685,190.77; P < .001).
Coronary CTA for ED risk stratification and disposition within a closed referral system resulted in the shortest ED LOS published to date while being safe and cost-effective.
冠状动脉CT血管造影（CTA）是急诊科（ED）评估胸痛的有力工具。对于其在低至中度风险人群中的成本效益仍存在一些争议。
本研究旨在评估在闭环转诊系统中，冠状动脉CTA对因胸痛就诊于急诊科的低至中度风险患者的安全性和成本效益。
通过当地快速冠状动脉CTA方案对胸痛患者在急诊科进行评估，并与接受常规治疗的年龄匹配队列进行前瞻性跟踪，比较急诊科的诊疗流程、处置情况、胸痛复发率和成本利用情况。
183例患者接受了快速冠状动脉CTA方案，与之相比，184例接受常规治疗的年龄匹配队列。冠状动脉CTA组主要不良心血管事件的中位随访期为9.0个月（范围1.8 - 14.5个月），年龄匹配队列中位随访期为11.1个月（范围0 - 14.0个月）。快速冠状动脉CTA队列的急诊科中位住院时间（LOS）为5.8小时（范围2.6 - 12.3小时），年龄匹配队列的中位住院时间为12.2小时（范围1.7 - 40.3小时）（P < .001）。冠状动脉CTA检查的中位时间为2.5小时（范围0.4 - 8.7小时），从冠状动脉CTA检查到处置的中位时间为2.9小时（范围0.8 - 8.6小时）。快速冠状动脉CTA队列的总中位住院时间为5.9小时（范围但2.7 - 124小时），年龄匹配队列的总中位住院时间为25.0小时（范围1.2 - 208小时）（P < .001）。年龄匹配队列中住院更为常见（98.9%对9.3%；P < .001）。与常规治疗相比，冠状动脉CTA组的总支付者成本显著降低（182,064.55美元对685,190.77美元；P < .001）。
在闭环转诊系统中，用于急诊科风险分层和处置的冠状动脉CTA导致了迄今为止最短的急诊科住院时间，同时具有安全性和成本效益。
