Harvard Heart Letter

ER evaluation methods compared

When someone is admitted to the emergency department with chest pain, tests are conducted to diagnose or rule out a heart attack or pending heart attack. Results are often inconclusive, and a decision must be made whether to admit the person to the hospital for observation. Harvard researchers led a nationwide study to evaluate whether contrast-enhanced computed coronary tomographic angiography (CCTA) could aid in making a definitive diagnosis. A noninvasive technology, CCTA is valued for its accuracy in detecting and ruling out clinically significant coronary artery disease (CAD). The study randomized 1,000 people with chest pain admitted to the emergency departments of nine hospitals to undergo either standard evaluation or CCTA. Those who were screened with CCTA spent an average of 7.6 fewer hours in the hospital. Half of those screened with CCTA, but only 10% of those screened with standard methods, were discharged within 8.6 hours. Both methods accurately diagnosed all cases of heart attack or pending heart attack, meaning no diagnoses were missed. In the 28 days after discharge, more invasive follow-up tests were conducted in those who had undergone CCTA than in those who had undergone the standard procedure. As a result, there was no reduction in the cost of care. CCTA also resulted in more radiation exposure.

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