“Triple-Rule-Out” in Investigating Cases of Acute Chest Pain (Saudi Experience)

Abstract

Objective: Triple Rule-Out (TRO) is a recent Technique for evaluating Emergency Department (ED) acute Chest Pain Patients. The aim of this study is to assess the effectiveness of TRO in identifying the cause of acute chest in emergency department. Materials and Methods:This is a prospective study done in Kingdom of Saudi Arabia (KSA) tertiary referral hospital during the period between March 2014 and June 2017. 237 patients who fulfill the inclusion criteria and continue all follow up visits for six months were included. They were presented to ED with acute chest pain suspected to be acute coronary syndrome. Their ages ranged between 29 and 72 years old with the mean age of 42.8 years. 164 patients were males and the rest were females. TRO was performed to all of them using a 64 and 128 Multi-Detector Computed Tomography (MDCT) scanners. Results:According to the results of TRO, the patients had fallen into one of the three groups: (1) Patients with coronary artery disease including 62 patients (26.2%) and were classified according to the severity of the coronary artery stenosis into mild, moderate, and severe stenosis subgroups.(2) Patients with extra-coronary diseases that explain patient's complaints including 94 patients (39.7%). (3) Patients without obvious disease which can explain patient's complaints including 81 patients (34.1%). Additional 136 extra-coronary incidental findings which are not related to the presenting complaints were reported and were treated accordingly.Conclusions: TRO examination is a fast and useful technique in mak¬ing a quick and accurate diagnosis in patients presented to ED with acute non-traumatic chest pain. It allows imaging of the coronary arteries, entire chest, and upper abdominal organs with rapid acquisition and data reconstruction to provide prompt and accurate diagnosis. It is also used to identify many of clinically significant non-cardiac findings that may have an impact on the management of those patients.