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Journal Club 4 April 2012


CT Angiography for Safe Discharge of Patients with Possible Acute Coronary Syndromes




Multicentre US randomised clinical trial


Low to intermediate risk patients with possible acute coronary syndrome (age>30 and TIMI score 0 to 2)


CT Coronary Angiography


Traditional care


The primary outcome
was safety, assessed in the subgroup of patients with a negative CCTA examination,
with safety defined as the absence of myocardial infarction and cardiac death
during the first 30 days after presentation.


1370 subjects: 908 in the CCTA group and 462 in the group receiving traditional
care. The baseline characteristics were similar in the two groups. Of 640 patients
with a negative CCTA examination, none died or had a myocardial infarction
within 30 days (0%; 95% confidence interval [CI], 0 to 0.57). As compared with patients
receiving traditional care, patients in the CCTA group had a higher rate of discharge
from the emergency department (49.6% vs. 22.7%; difference, 26.8 percentage
points; 95% CI, 21.4 to 32.2), a shorter length of stay (median, 18.0 hours vs.
24.8 hours; P<0.001), and a higher rate of detection of coronary disease (9.0% vs.
3.5%; difference, 5.6 percentage points; 95% CI, 0 to 11.2). There was one serious
adverse event in each group.


A CCTA-based strategy for low-to-intermediate-risk patients presenting with a possible
acute coronary syndrome appears to allow the safe, expedited discharge from the
emergency department of many patients who would otherwise be admitted.

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