Ccta journal club


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  • major adverse cardiovascular events (defined as death, myocardial infarction, unstable angina, or urgent coronary revascularization within 28 days),undetected acute coronary syndrome (defined as an unexpected cardiovascular event within 72 hours after hospital discharge in patients with a hospital stay of <24 hours)Periprocedural complications (stroke, bleeding, anaphylaxis, or renal failure)
  • What did they do for
  • Ccta journal club

    1. 1. Background Chest Pain due to ACS is one of the most common presentations to ER Current strategies to R/O ACS are inefficient – Unnecessary admissions and ER overcrowded Despite low threshold to admit patients up to 2% of patients Discharged with missed ACS
    2. 2. Cardiac CT Angiography Previous studies Showed that CCTA has Accurate Noninvasive Detection of significant CAD with High NPV during the index hospitalization and the occurrence of major adverse cardiovascular events over the next 2 years Hollander JE, Chang AM, Shofer FS, et al. One-year outcomes following coronary computerized tomographic angiography for evaluation of emergency department patients with potential acute coronary syndrome. Acad Emerg Med 2009;16:693-8 Schlett CL,, et al.Prognostic value of CT angiography for major adverse cardiac events in patients with acute chest pain from the emergency department: 2-year outcomes of the ROMICAT trial. JACC Cardiovasc Imaging 2011;4:481-91
    3. 3. The hypothesis An evaluation strategy incorporating early CCTA will improve the effectiveness of clinical decision making as compared to a Standard ED Evaluation in Patients with acute chest pain suggestive of ACS Study Type : Diagnostic cohort Study Design : RCT
    4. 4. P  40 to 74 years of age with symptoms suggestive of ACS but without ischemic ECG Changes or an initial positive troponin testI  CCTAC  Standard EvaluationO  Primary End Point, length of stay in the hospital
    5. 5. Secondary Endpoints Rates of direct discharge from the ED Cumulative costs Cumulative radiation exposure Time to diagnosis Safety variables (Periprocedural complications, undetected acute coronary syndrome within 72 hrs after discharge, MACE at 28 days) Utilization of other diagnostic testing Resource utilization
    6. 6. Inclusion Criteria Patients with > 5 min of Chest Pain or Angina Equivelant within the past 24 hours 40 to 74 years of age sinus rhythm Patients Patient must be able to Hold Breath >10 seconds Patient must be able to sign an informed consent
    7. 7. Exclusion Criteria History of known coronary artery disease !! New diagnostic ischemic changes on the initial ECG Initial troponin level in excess of the 99th percentile of the local assay Impaired renal function Hemodynamic or clinical instability, Known allergy to an iodinated contrast agent Body Mass Index greater than 40 Currently symptomatic asthma.
    8. 8. Was the assignment ofpatients to treatmentsrandomized? Yes, randomly assigned in a 1:1 ratio
    9. 9. Was the randomizationConcealed ? No
    10. 10. Were the groups similar atthe start of the trial? Yes
    11. 11. Aside from the allocatedtreatment were groups treatedequally? Yes, and both arms were Followed up for 28 Days
    12. 12. Were all patients who enteredthe trial accounted for? No, Almost 1% lost the Follow up
    13. 13. Were Patients analysed in thegroups to which they wererandomized? Yes, with the use of intention to treat analysis
    14. 14. Were measures objective? Yes, they were objectives (Length of stay and cost and Radiation Exposure)
    15. 15. Were the patients andclinicians kept “blind” towhich treatment was beingreceived? No, it wasn’t Blind
    16. 16. Results
    17. 17. Summary CCTA has: High Diagnostic Accuracy Less Time to Dx More Direct Discharge From ER Reduce Length of stay More cost !! More Radiation
    18. 18. Will the results help me incaring for my patient? Yes, But to a limited group of patients
    19. 19. Applicability of the study Patients were recruited at weekday daytime hours Patients with History of  Known coronary artery disease  Hemodynamic or clinical instability  Impaired renal function  Limited age group were excluded We can Apply CCTA in our institution