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Usefulness of 64-slice MDCT as an initial diagnostic approach in patients with acute chest pain Sung-A Chang, Sang Il Choi, Eue-Keun Choi, et al.  Am Heart J 2008;156:375-83 Journal Club  7 th  August 2008 Dr. Rashidi Ahmad Dr. Emily Tan Dato’ Dr. Azhari Rosman
Introduction ,[object Object],[object Object],[object Object],[object Object],Pope JH, et al. Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med 2000;342:1163-70.
Rationale of the study ,[object Object],[object Object],[object Object],[object Object],Antman EM, et al. The TIMI risk score for USA/NSTEMI: a method for prognostication and therapeutic decision making. JAMA 2000;284:835-42.
MDCT ,[object Object],Raff GL, et al. Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J Am Coll Cardiol 2005;46:552-7.  Johnson TR, et al. ECG-gated 64- MDCT angiography in the differential diagnosis of acute chest pain. Am J Roentgenol 2007;188:76-82.
MDCT ,[object Object],[object Object],White CS, et al. Chest pain evaluation in the ED: can MDCT provide a comprehensive evaluation? Am J Roentgenol 2005;185:533-40. Rubinshtein R, et al. Usefulness of 64-slice MDCT for diagnosing ACS & predicting clinical outcome in ED patients with chest pain of uncertain origin. Circulation 2007;115:1762-8.
Objectives  ,[object Object],[object Object],[object Object],[object Object],[object Object]
Measured outcome ,[object Object],[object Object],[object Object],[object Object]
 
Methods ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
MDCT protocol ,[object Object],[object Object],[object Object]
A month after the index ED visit, clinical status and cardiac events were assessed by individual interviews and using the hospital computer database. 2 cardiologist
Statistical analysis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
(high,  intermediate, low probability) 21% 42% 37%
Low probability patients: younger and had less history of hypertension, diabetes, dyslipidemia & CAD than high-probability patients
MDCT image acquisition ,[object Object],[object Object],[object Object],[object Object]
P:0.07 144 (54%) patients were discharged from the ED and 122 (46%) patients were hospitalized
 
Study outcome ,[object Object],[object Object]
[object Object],[object Object]
Emergency department  LOS ,[object Object],[object Object],[object Object]
Hospital LOS ,[object Object],[object Object]
A, Length of ED stay showed no difference between the conventional and MDCT-based strategies, which was similar in subgroup analysis according to the risk for ACS.  B, Length of hospital stay tended to be lower in the MDCT-based strategy. In subgroup analysis, hospital LOS was significantly reduced in high-risk patients (*P < .05).
F/up ,[object Object],[object Object],[object Object],[object Object]
Study limitations/opportunity ,[object Object],[object Object]
Conclusions ,[object Object],[object Object]

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Mdct2

  • 1. Usefulness of 64-slice MDCT as an initial diagnostic approach in patients with acute chest pain Sung-A Chang, Sang Il Choi, Eue-Keun Choi, et al. Am Heart J 2008;156:375-83 Journal Club 7 th August 2008 Dr. Rashidi Ahmad Dr. Emily Tan Dato’ Dr. Azhari Rosman
  • 2.
  • 3.
  • 4.
  • 5.
  • 6.
  • 7.
  • 8.  
  • 9.
  • 10.
  • 11.
  • 12. A month after the index ED visit, clinical status and cardiac events were assessed by individual interviews and using the hospital computer database. 2 cardiologist
  • 13.
  • 14. (high, intermediate, low probability) 21% 42% 37%
  • 15. Low probability patients: younger and had less history of hypertension, diabetes, dyslipidemia & CAD than high-probability patients
  • 16.
  • 17. P:0.07 144 (54%) patients were discharged from the ED and 122 (46%) patients were hospitalized
  • 18.  
  • 19.
  • 20.
  • 21.
  • 22.
  • 23. A, Length of ED stay showed no difference between the conventional and MDCT-based strategies, which was similar in subgroup analysis according to the risk for ACS. B, Length of hospital stay tended to be lower in the MDCT-based strategy. In subgroup analysis, hospital LOS was significantly reduced in high-risk patients (*P < .05).
  • 24.
  • 25.
  • 26.

Notes de l'éditeur

  1. There were no significant differences in patient baseline characteristics between the conventional and MDCT strategies (