Scientific Session 25 — Cardiac - CoronaryThursday, May 4, 2017
2853. Coronary CT Angiography in a Large County Hospital Emergency Department: Initial Experience
Prosper A*, Sakioka J, Wilcox A, Garg P, Lee C. University of Southern California, Los Angeles, CA
Address correspondence to A. Prosper (email@example.com)
Objective: In February 2015, we launched a coronary CT angiography (CCTA) program for acute chest pain in the Los Angeles County and University of Southern California Emergency Department (ED). Feasibility of instituting a CCTA program in an underserved population such as ours has not been well-studied.
Materials and Methods: The first 100 CCTA examinations ordered through our ED were retrospectively reviewed. TIMI (thrombolysis in myocardial infarction) scores, history, ECG results, age, risk factors, and troponin levels were obtained from the medical record. CCTA examinations were assessed for image quality, coronary artery disease (CAD), coronary artery calcium scores, and significant incidental findings. Invasive coronary angiography (ICA), when performed, was correlated with CCTA results.
Results: 60 male and 40 female patients were included, with an average age of 52.6 years (range, 27–75 years). Thirty-one patients had a TIMI score of 0, 65 had TIMI scores of 1–2, and four had TIMI scores of 3. Of 87 examinations with calcium scoring, 66 patients had total calcium scores less than 100, 12 scored 100–400, and nine scored greater than 400 (range, 0–3740). CCTA examinations were performed for 97/100 patients, and the remaining three patients did not receive an CCTA examination following the presence of excessive coronary calcifications on the calcium scoring scans. 85/97 (88%) scans were rated as good or excellent image quality, 6/97 (6%) were deemed fair quality, and 6/97 (6%) were considered poor quality. Of the six scans with poor image quality, two patients received ICA as the diagnostic portions of the examinations indicated high grade stenosis, two patients underwent subsequent echocardiography (one with stress testing), one was admitted for observation, and one was discharged home. CCTA demonstrated 50% or greater stenosis in at least one coronary artery in 18/97 (19%) patients, 16 of whom underwent subsequent ICA examination. Seven patients received percutaneous coronary intervention, and four patients ultimately underwent coronary artery bypass grafting. 75/97 (77%) patients were discharged immediately after CCTA interpretation. Significant incidental findings included diagnosis of type B aortic dissection in a patient without evidence of CAD.
Conclusion: Implementing a CCTA program for patients with acute chest pain in a busy, underserved ED is feasible. Our initial experience demonstrates CCTA to be a highly effective and accurate triaging tool, allowing for direct ED discharge or referral for invasive testing.