Key result
Early CCTA reduced median length of stay for both African American and Caucasian patients presenting to the ED with chest pain by approximately 17 hours compared with standard evaluation (P<0.001).
Why the study?
Does early coronary computed tomographic angiography reduce length of stay compared to standard emergency department evaluation in Caucasian and African American patients presenting with acute chest pain?
RCT (n=940)
randomized
Yes
Does early coronary computed tomographic angiography reduce length of stay compared to standard emergency department evaluation in Caucasian and African American patients presenting with acute chest pain?
p-value: p=<0.001
Early CCTA reduces emergency department length of stay by approximately 17 hours compared to standard evaluation, with similar benefit observed in both African American and Caucasian patients.
May reduce ED length of stay similarly across groups; hypothesis-generating and requires randomized confirmation before practice change.
Objective: To examine racial differences in outcomes with coronary computed tomographic angiography (CCTA) vs standard emergency department (ED) evaluation for chest pain. Design: Retrospective analysis of the prospective, randomized, multicenter Rule Out Myocardial Ischemia/Infarction by Computer Assisted Tomography (ROMICAT-II) trial. Setting: ED at nine hospitals in the United States. Participants: 940 patients who were Caucasian or African American (AA) presenting to the ED with chest pain. Interventions: CCTA or standard ED evaluation. Main Outcome Measures: Length of stay, hospital admission, direct ED discharge, downstream testing and repeat ED visit or hospitalization for recurrent chest pain at 28 days. Safety end points: missed acute coronary syndrome (ACS) and cumulative radiation exposure during the index visit and follow-up period. Results: 659 (66%) patients self-identified as Caucasian and 281 (28%) self-identified as AA. AA were younger and more often female compared with Caucasians, had a higher prevalence of hypertension (64% vs 49%, P<.001) and diabetes (23% vs 14%, P<.001) and a lower prevalence of hyperlipidemia (28% vs 51%, P<.001). ACS was more frequent among Caucasians (10% vs 2%, P<.001). Randomization to CCTA resulted in a reduction in median LOS for Caucasians (7.4 vs 24.7 hours, P<.001) and AA (8.9 vs. 26.3, P<.001; P-interaction=.88). Both AA and Caucasian patients experienced greater radiation exposure and more downstream testing with CCTA compared with standard evaluation. Conclusions: Early CCTA reduced median LOS for both AA and Caucasian patients presenting to the ED with chest pain by approximately 17 hours compared with standard evaluation.
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Reinhardt et al. (2018) conducted an RCT in acute chest pain (n=940). Coronary computed tomographic angiography (CCTA) vs. Standard emergency department (ED) evaluation was evaluated on Length of stay (p=<0.001). Early CCTA reduced median length of stay for both African American and Caucasian patients presenting to the ED with chest pain by approximately 17 hours compared with standard evaluation (P<0.001).
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