Fadeyi Olaniyi, Saghari Saviz, Dang Varun, Shankar Abhirami, Singh Harpreet
Internal Medicine, West Anaheim Medical Center, Anaheim, USA.
Cardiology, West Anaheim Medical Center, Anaheim, USA.
Cureus. 2025 Jan 25;17(1):e77962. doi: 10.7759/cureus.77962. eCollection 2025 Jan.
Acute chest pain is one of the most common reasons for ED visits in the United States. Most patients are eventually admitted to the hospital to "rule out ACS" even when there are no significant EKG abnormalities or elevated cardiac enzymes. In addition to undergoing expensive tests while in the hospital, patients are also exposed to iatrogenic harm thereby worsening the overall healthcare costs. Meanwhile, the use of coronary computed tomography angiography (CTA) as a "gatekeeper" diagnostic test for patients with low to intermediate risk for coronary artery diseases (CADs) has significantly lowered hospital admissions and associated costs. However, coronary CTA may not be helpful for all classes of patients. Therefore, this study seeks to determine if the distribution of patients presenting to the ED with chest pain in an acute care facility will justify an investment in coronary CTA and contribute to lowering healthcare costs. Patients' data between July 2022 and June 2023 were considered in our analysis. Results revealed that a significant number of patients who presented to the ED for chest pain and were subsequently admitted to the hospital for further work-up would have benefited from coronary CTA screening without any need for further inpatient work-up. Also, cost analysis showed that the use of coronary CTA would have helped significantly lower healthcare costs in this facility.
在美国，急性胸痛是急诊就诊最常见的原因之一。即使心电图没有明显异常或心肌酶没有升高，大多数患者最终仍会被收治入院以“排除急性冠状动脉综合征（ACS）”。患者在住院期间不仅要接受昂贵的检查，还会受到医源性伤害，从而增加了总体医疗费用。与此同时，对于冠状动脉疾病（CAD）低至中度风险的患者，使用冠状动脉计算机断层扫描血管造影（CTA）作为“守门人”诊断测试，显著降低了住院率和相关费用。然而，冠状动脉CTA可能并非对所有类型的患者都有帮助。因此，本研究旨在确定在一家急症护理机构中，因胸痛到急诊就诊的患者分布情况是否足以证明投资冠状动脉CTA的合理性，并有助于降低医疗成本。我们的分析考虑了2022年7月至2023年6月期间患者的数据。结果显示，大量因胸痛到急诊就诊、随后被收治入院进行进一步检查的患者，本可从冠状动脉CTA筛查中受益，而无需进一步住院检查。此外，成本分析表明，使用冠状动脉CTA将有助于显著降低该机构的医疗成本。
