Key result
Coronary CTA triage in the ED is linked to lower costs and fewer unnecessary admissions.
Why the study?
Most ED chest pain patients without significant EKG changes or enzyme elevations are admitted to rule out ACS, increasing costs and iatrogenic risk, and whether patient distribution in an acute care facility justifies investing in coronary CTA to lower costs remains uncertain.
Does hypothetical triage with coronary CTA reduce healthcare costs and unnecessary hospital admissions compared to standard inpatient work-up in patients presenting to the ED with low-to-intermediate risk acute chest pain?
Observational
No
Does hypothetical triage with coronary CTA reduce healthcare costs and unnecessary hospital admissions compared to standard inpatient work-up in patients presenting to the ED with low-to-intermediate risk acute chest pain?
Triage of low-to-intermediate risk acute chest pain patients using coronary CTA in the ED could significantly reduce unnecessary hospital admissions and lower healthcare costs compared to standard inpatient work-up.
May support CTA triage to reduce costs and admissions in low-intermediate risk ED chest pain; leaves open need for randomized trials.
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.
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Fadeyi et al. (2025) conducted an observational in Acute chest pain with low to intermediate risk for CAD. Coronary CTA vs. Current standard of care was evaluated on Healthcare costs and hospital admissions. Using coronary CTA to triage ED patients with low to intermediate risk for CAD would have significantly lowered healthcare costs and reduced unnecessary inpatient admissions.
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