冠状动脉 CT 血管造影与应激超声心动图在急性胸痛中的比较：一项随机对照试验。
Coronary Computed Tomography Angiography Versus Stress Echocardiography in Acute Chest Pain: A Randomized Controlled Trial.
机构信息
Department of Radiology, Division of Cardiothoracic Imaging, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York; Department of Internal Medicine, Division of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.
Department of Radiology, Division of Cardiothoracic Imaging, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York; Department of Internal Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.
出版信息
JACC Cardiovasc Imaging. 2018 Sep;11(9):1288-1297. doi: 10.1016/j.jcmg.2018.03.024. Epub 2018 Jun 13.
OBJECTIVES
This study sought to compare early emergency department (ED) use of coronary computed tomography angiography (CTA) and stress echocardiography (SE) head-to-head.
BACKGROUND
Coronary CTA has been promoted as the early ED chest pain triage imaging method of choice, whereas SE is often overlooked in this setting and involves no ionizing radiation.
METHODS
The authors randomized 400 consecutive low- to intermediate-risk ED acute chest pain patients without known coronary artery disease and a negative initial serum troponin level to immediate coronary CTA (n = 201) or SE (n = 199). The primary endpoint was hospitalization rate. Secondary endpoints were ED and hospital length of stay. Safety endpoints included cardiovascular events and radiation exposure.
RESULTS
Mean patient age was 55 years, with 43% women and predominantly ethnic minorities (46% Hispanics, 32% African Americans). Thirty-nine coronary CTA patients (19%) and 22 SE patients (11%) were hospitalized at presentation (difference 8%; 95% confidence interval: 1% to 15%; p = 0.026). Median ED length of stay for discharged patients was 5.4 h (interquartile range [IQR]: 4.2 to 6.4 h) for coronary CTA and 4.7 h (IQR: 3.5 to 6.0 h) for SE (p < 0.001). Median hospital length of stay was 58 h (IQR: 50 to 102 h) for coronary CTA and 34 h (IQR: 31 to 54 h) for SE (p = 0.002). There were 11 and 7 major adverse cardiovascular events for coronary CTA and SE, respectively (p = 0.47), over a median 24 months of follow-up. Median/mean complete initial work-up radiation exposure was 6.5/7.7 mSv for coronary CTA and 0/0.96 mSv for SE (p < 0.001).
CONCLUSIONS
The use of SE resulted in the hospitalization of a smaller proportion of patients with a shorter length of stay than coronary CTA and was safe. SE should be considered an appropriate option for ED chest pain triage (Stress Echocardiography and Heart Computed Tomography [CT] Scan in Emergency Department Patients With Chest Pain; NCT01384448).
目的
本研究旨在比较冠状动脉计算机断层扫描血管造影（CTA）与应激超声心动图（SE）在急诊科的早期应用。
背景
冠状动脉 CTA 已被推荐为急诊科胸痛的首选早期影像学分诊方法，而 SE 在这种情况下往往被忽视，并且不涉及电离辐射。
方法
作者将 400 例低危至中危的急诊科急性胸痛患者（无已知冠状动脉疾病且初始血清肌钙蛋白水平阴性）随机分为立即进行冠状动脉 CTA（n=201）或 SE（n=199）。主要终点是住院率。次要终点是急诊科和医院的住院时间。安全性终点包括心血管事件和辐射暴露。
结果
患者平均年龄为 55 岁，女性占 43%，主要为少数民族（46%西班牙裔，32%非裔美国人）。39 例冠状动脉 CTA 患者（19%）和 22 例 SE 患者（11%）在就诊时住院（差异 8%；95%置信区间：1%至 15%；p=0.026）。出院患者的急诊科中位住院时间为冠状动脉 CTA 组 5.4 小时（四分位距 [IQR]：4.2 至 6.4 小时），SE 组 4.7 小时（IQR：3.5 至 6.0 小时）（p<0.001）。冠状动脉 CTA 组的中位住院时间为 58 小时（IQR：50 至 102 小时），SE 组为 34 小时（IQR：31 至 54 小时）（p=0.002）。在中位 24 个月的随访中，冠状动脉 CTA 组和 SE 组分别有 11 例和 7 例主要不良心血管事件（p=0.47）。冠状动脉 CTA 的初始完整检查辐射暴露中位数/平均值为 6.5/7.7 mSv，SE 为 0/0.96 mSv（p<0.001）。
结论
与冠状动脉 CTA 相比，SE 用于急诊科胸痛分诊可使较少比例的患者住院，且住院时间更短，安全性更高。SE 应被视为急诊科胸痛分诊的合适选择（应激超声心动图和心脏计算机断层扫描在急诊科胸痛患者中的应用；NCT01384448）。
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