Department of Radiology and Radiological Science, Division of Cardiovascular Imaging.
Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
J Thorac Imaging. 2020 May;35(3):198-203. doi: 10.1097/RTI.0000000000000474.
The purpose of this study was to evaluate the utilization of invasive and noninvasive tests and compare cost in patients presenting with chest pain to the emergency department (ED) who underwent either triple-rule-out computed tomography angiography (TRO-CTA) or standard of care.
We performed a retrospective single-center analysis of 2156 ED patients who presented with acute chest pain with a negative initial troponin and electrocardiogram for myocardial injury. Patient cohorts matched by patient characteristics who had undergone TRO-CTA as a primary imaging test (n=1139) or standard of care without initial CTA imaging (n=1017) were included in the study. ED visits, utilization of tests, and costs during the initial episode of hospital care were compared.
No significant differences in the diagnosis of coronary artery disease, pulmonary embolism, or aortic dissection were observed. Median ED waiting time (4.5 vs. 7.0 h, P<0.001), median total length of hospital stay (5.0 vs. 32.0 h, P<0.001), hospital admission rate (12.6% vs. 54.2%, P<0.001), and ED return rate to our hospital within 30 days (3.5% vs. 14.6%, P<0.001) were significantly lower in the TRO-CTA group. Moreover, reduced rates of additional testing and invasive coronary angiography (4.9% vs. 22.7%, P<0.001), and ultimately lower total cost per patient (11,783$ vs. 19,073$, P<0.001) were observed in the TRO-CTA group.
TRO-CTA as an initial imaging test in ED patients presenting with acute chest pain was associated with shorter ED and hospital length of stay, fewer return visits within 30 days, and ultimately lower ED and hospitalization costs.
本研究旨在评估在因胸痛而到急诊科就诊的患者中，行三导联 CT 血管造影术（TRO-CTA）或标准护理的患者中，侵袭性和非侵袭性检查的应用情况，并比较成本。
我们对因胸痛且初始肌钙蛋白和心电图均未提示心肌损伤的 2156 例急诊科患者进行了回顾性单中心分析。将行 TRO-CTA 作为主要影像学检查的患者（n=1139）和未行初始 CTA 影像学检查的患者（n=1017）按患者特征匹配，纳入本研究。比较两组患者的急诊科就诊次数、检查应用情况和首次住院期间的费用。
两组在冠状动脉疾病、肺栓塞或主动脉夹层的诊断方面无显著差异。TRO-CTA 组的中位急诊科等待时间（4.5 vs. 7.0 h，P<0.001）、中位总住院时间（5.0 vs. 32.0 h，P<0.001）、住院率（12.6% vs. 54.2%，P<0.001）和 30 天内返回我院的急诊科就诊率（3.5% vs. 14.6%，P<0.001）显著更低。此外，TRO-CTA 组的进一步检查和有创冠状动脉造影的发生率更低（4.9% vs. 22.7%，P<0.001），且每位患者的总费用也更低（11783$ vs. 19073$，P<0.001）。
在因胸痛而到急诊科就诊的患者中，将 TRO-CTA 作为初始影像学检查与较短的急诊科和住院时间、30 天内的复诊率降低以及最终较低的急诊科和住院费用相关。
