“Could save millions of health care dollars and countless hours spent waiting on unnecessary tests.”
Researchers at Houston’s Methodist DeBakey Heart & Vascular Center have shown that a simple, inexpensive test can determine whether it is safe to send home a patient who comes to the emergency room with chest pain.
“It is imperative to accurately diagnose patients who come to the emergency department with chest pain,” said DeBakey cardiologist Dr. John Mahmarian, MD - principal investigator of the study. “Unfortunately, diagnosing chest pain is often expensive and time-consuming. This new data could save millions of health care dollars and countless hours spent waiting on unnecessary tests.”
Dr. Mahmarian’s research, published Feb 8 by Annals of Emergency Medicine,(1) shows that patients with a coronary artery calcium score of zero can be safely sent home without further cardiac testing.
Coronary artery calcium scoring (CACS) is a simple and readily available test for identifying coronary artery disease. CACS is done with a computed topography (CT) scanner. A CT scan uses X-rays to make a detailed image of the heart, showing calcium build up in the coronary arteries. The images can be read almost immediately after the scan. A CACS of zero correlates with an excellent short-term outcome and predicts a normal SPECT, which is a more advanced imaging test that is usually done following a CACS test.
About the Study
Dr. Mahmarian’s team conducted a prospective observational cohort study at The Methodist Hospital in Houston, an urban tertiary care hospital, of stable patients presenting to the emergency department (ED) with chest pain of uncertain cardiac etiology. Patients with a normal initial troponin, nonischemic ECG, and no history of CAD had stress myocardial perfusion imaging (SPECT) and CACS within 24 hours of ED admission. Cardiac events were defined as an acute coronary syndrome during the index hospitalization or in follow-up. CACS results were assessed in relation to SPECT findings and cardiac events.
The 1,031 patients enrolled had a median CACS of zero (61 percent with CACS of zero). The frequency of an abnormal SPECT ranged from 0.8 percent (CACS of zero) to17 percent (CACS more than 400). Cardiac events occurred in 32 patients (3.1 percent) during the index hospitalization (N=28) or following hospital discharge (N=4) (mean 7.4 [3.3] months). Only two events occurred in 625 patients with a CACS of 0 (0.3 percent, 95 percent CI 0.04 to 1.1). Both of these patients developed elevated troponins during their index visit, but had normal serial ECG and SPECT studies and no cardiac events at six month follow-up.
The study findings indicate that a majority of patients (61 percent in their sample) evaluated for chest pain of uncertain cardiac etiology have a CACS of zero, which predicts both a normal SPECT and an excellent short-term outcome.
Properly selected patients similar to those enrolled in this study who have a CACS of zero can be discharged home without further cardiac testing.
1. “Coronary Artery Calcium Scoring in the Emergency Department: Identifying Which Patients with Chest Pain Can Be Safely Discharged Home”
Source: Methodist Hospital, Houston news release Feb 8, 2010