ROLE OF CORONARY CT IN THE EMERGENCY ROOM IN THE PATIENTS WITH CHEST PAIN

Abstract

Abstract Objective Assess the use of Coronary CT in patients attending the emergency room (ED) with chest pain and/or doubtful signs/symptoms of acute coronary syndrome (ACS). Background Patients coming to the ED for chest pain are an important challenge. According to the guidelines (ESC 2023) it is necessary a fast selection between those who need hospitalization and urgent coronary angiography (rule–in) and those who can be discharged home (rule–out). However, it is difficult to obtain an early diagnosis and therefore patients often need a prolonged observation. Materials and Methods We subjected to Coronary CT 104 patients (pts) with symptoms and/or alteration of parameters suspected for ACS (ECG, echocardiography, high sensitivity troponin) arrived in the cardiological holding (cardiological observation) of the San Camillo Forlanini Hospital from the emergency room. Clinical–instrumental data, incidence of positive results on Coronary CT and concordance with coronary angiography, waiting time for the examination and length of hospitalization were retrospectively evaluated. Results The average age of the pts was 56 ± 2 years, 65 men (62.5%) 39 women (37.5%). Coronary CT exams were performed on the first day after admission to the ED in 83% of cases. Pts presented with chest pain (61% noncardiac, 13% cardiac), and/or palpitations (10%), and/or dyspnea, presyncope, or syncope (overall 16%). CT was performed in 79% of cases due to the association of symptoms and instrumental findings (ECG 54% of cases, hs troponin 34%, echocardiogram 12%); in 21% only for clinical findings. Coronary CT excluded obstructive coronary artery disease in 95 out of 104 pts (91.3%) and was positive in 6/104 pts (5.8%), with coronary angiographic correspondence in 5 cases. In 3/104 (2.9%) the test resulted doubtful/positive (angiographic confirmation in a single case). Only 8.7% of pts underwent coronary angiography (those with positive or doubtful CT result). In all pts with chest pain only (21%) the Coronary CT was negative. Troponin positivity (34% of pts) was not strictly associated with the presence of coronary artery disease: in 94% of pts with positive hs troponin (average value 500 pg/mL) the CT scan did not show critical lesions. The average stay of pts with negative Coronary CT was 1.5 days. Conclusions Coronary CT can significantly reduce the use of coronary angiography and the length of stay in pts coming in ED with chest pain and/or doubtful signs/symptoms of ACS.