Key result
TRO CTA enables safe discharge without further testing for ~44% of intermediate-risk chest pain patients.
Why the study?
The utility of triple-rule-out CT angiography to guide clinical decisions in emergency department patients presenting with acute chest pain and intermediate risk for ACS needed to be estimated.
Does Triple-rule-out CT angiography guide clinical decision making and early triage in acute chest pain patients with intermediate risk to acute coronary syndrome?
Observational (n=45)
Yes
Does Triple-rule-out CT angiography guide clinical decision making and early triage in acute chest pain patients with intermediate risk to acute coronary syndrome?
Triple-rule-out CT angiography is an effective triage tool for intermediate-risk acute chest pain patients in the emergency department, allowing safe discharge or definitive diagnosis of coronary, aortic, or pulmonary pathologies.
May support early discharge decisions in intermediate-risk chest pain; extends Level 3 data but leaves open need for RCTs before practice change.
In our study, we aimed to estimate utility of TRO CTA to guide clinical decision in acute chest pain patients with intermediate risk to acute coronary syndrome (ACS) in the emergency department. Our study population included 45 acute chest pain patients with intermediate-risk ACS. All these patients had done TRO CTA to access any pathological conditions in the coronary artery, pulmonary artery, aorta and thoracic diseases that may be the cause of their complaint. Follow-up was done in all patients for 60 days. Among the 45 patients, we were able to discharge 44.4% (20 out of 45) of our population safely to home with no need for further diagnostic cardiac testing. The rest of the patients were classified into significant coronary artery disease 40% (18 out of 45), 8.8% (4 out of 45) had acute aortic lesions and 6.6% (3 out 45) had pulmonary artery embolization. Triple Role Out CT angiography (TRO CTA) is not only an effective protocol for exclusion of ACS with high specificity compared to dedicated coronary CTA but also in the diagnosis of acute chest pain due to other vascular and non-vascular causes helping decision-making strategy for admission in the emergency department.
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El‐Tabbakh et al. (2019) conducted an observational in Acute chest pain with intermediate risk for acute coronary syndrome (n=45). Triple-rule-out CT angiography (TRO CTA) was evaluated on Safe discharge without need for further diagnostic cardiac testing. Triple-rule-out CT angiography allowed for the safe discharge of 44.4% of intermediate-risk acute chest pain patients without further diagnostic testing, while identifying significant coronary artery disease in 40%.
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