Sixty-four–slice multidetector computed tomography: the future of ED cardiac care

Halpern, Ethan J.; Takakuwa, Kevin M.

doi:10.1016/j.ajem.2006.10.012

Cited by 24 publications

(14 citation statements)

References 59 publications

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“…Advances in computed tomography (CT) have improved image quality and simplified the implementation of CT into a non-invasive cardiovascular imaging program [1][2][3][4][5]. The improved image quality has translated into an increased accuracy of CT images for the diagnosis of coronary artery disease (CAD) when compared to catheter-based imaging.…”

Section: Introductionmentioning

confidence: 99%

Initial evaluation of coronary images from 320-detector row computed tomography

Rybicki

Otero

Steigner

et al. 2008

Int J Cardiovasc Imaging

527

335

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Section: Introductionmentioning

confidence: 99%

Initial evaluation of coronary images from 320-detector row computed tomography

Rybicki

Otero

Steigner

et al. 2008

Int J Cardiovasc Imaging

527

335

View full text Add to dashboard Cite

show abstract

“…Fueled by technical innovations that have improved the anatomic resolution, sensitivity, and specificity of computed tomography (CT) and magnetic resonance imaging (MRI) modalities, medical practice has evolved to heavily rely on these imaging techniques over older, conventional radiographic imaging modalities (5)(6)(7)(8)(9). Indeed, many clinical practice guidelines, particularly in the emergent setting, have supplanted conventional radiography with CT and MRI examinations as the key elements in their clinical decision-making algorithm (4).…”

mentioning

confidence: 99%

“…Much of this evolution has been driven by evidence-based medicine of the superiority of cross-sectional imaging over conventional radiography in the accurate detection of disease (4,(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Advances in multidetector CT, dual-source CT, gradientbased MR pulse sequences, and novel pulse sequences have also greatly diminished the acquisition time of these studies, permitting a higher-throughput model of health care delivery (2,3,5,(20)(21)(22).…”

mentioning

confidence: 99%

The Effects of Changes in Utilization and Technological Advancements of Cross-Sectional Imaging on Radiologist Workload

McDonald¹,

Schwartz²,

Eckel³

et al. 2015

Academic Radiology

328

155

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“…In a study of 568 low-risk ED patients with chest pain, those with negative coronary CTA did not have any adverse outcomes (nonfatal AMI or death) within 30 days of the index ED visit [25]. Prior studies have shown that coronary CTA has high diagnostic accuracy (82-100% sensitivity, 82-98% specificity, negative predictive value of 95-100%) in low-risk patients for detection of coronary artery disease [26][27][28][29][30][31][32][33][34]. Coronary CTA has been shown to be as safe [17] and more cost effective [18] than other methods of evaluating these patients.…”

Section: Discussionmentioning

confidence: 99%

Coronary computerized tomography angiography for rapid discharge of low-risk patients with cocaine-associated chest pain

et al. 2009

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Background: Most patients presenting to emergency departments (EDs) with cocaine-associated chest pain are admitted for at least 12 hours and receive a "rule out acute coronary syndrome" protocol, often with noninvasive testing prior to discharge. In patients without cocaine use, coronary computerized tomography angiography (CTA) has been shown to be useful for identifying a group of patients at low risk for cardiac events who can be safely discharged. It is unclear whether a coronary CTA strategy would be efficacious in cocaine-associated chest pain, as coronary vasospasm may account for some of the ischemia. We studied whether a negative coronary CTA in patients with cocaine-associated chest pain could identify a subset safe for discharge.Methods: We prospectively evaluated the safety of coronary CTA for low-risk patients who presented to the ED with cocaineassociated chest pain (self-reported or positive urine test). Consecutive patients received either immediate coronary CTA in the ED (without serial markers) or underwent coronary CTA after a brief observation period with serial cardiac marker measurements. Patients with negative coronary CTA (maximal stenosis less than 50%) were discharged. The main outcome was 30-day cardiovascular death or myocardial infarction.Results: A total of 59 patients with cocaine-associated chest pain were evaluated. Patients had a mean age of 45.6 Ϯ 6.6 yrs and were 86% black, 66% male. Seventy-nine percent had a normal or nonspecific ECG and 85% had a TIMI score <2. Twenty patients received coronary CTA immediately in the ED, 18 of whom were discharged following CTA (90%). Thirty-nine received coronary CTA after a brief observation period, with 37 discharged home following CTA (95%). Six patients had coronary stenosis Ն50%. During the 30-day follow-up period, no patients died of a cardiovascular event (0%; 95% CI, 0-6.1%) and no patient sustained a nonfatal myocardial infarction (0%; 95% CI, 0-6.1%).Conclusions: Although cocaine-associated myocardial ischemia can result from coronary vasoconstriction, patients with cocaineassociated chest pain, a non-ischemic ECG, and a TIMI risk score <2 may be safely discharged from the ED after a negative coronary CTA with a low risk of 30-day adverse events.

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Sixty-four–slice multidetector computed tomography: the future of ED cardiac care

Cited by 24 publications

References 59 publications

Initial evaluation of coronary images from 320-detector row computed tomography

Initial evaluation of coronary images from 320-detector row computed tomography

The Effects of Changes in Utilization and Technological Advancements of Cross-Sectional Imaging on Radiologist Workload

Coronary computerized tomography angiography for rapid discharge of low-risk patients with cocaine-associated chest pain

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