NHLBI Study Finds CCTA for ER Chest Pain Patients Leads to Faster Diagnosis, Quicker Discharge
The eagerly awaited follow-up study to the National Heart, Lung, and Blood Institute (NHLBI) Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography (ROMICAT) study is out, and it could support adding coronary CT angiography (CCTA) to chest pain ER screening procedures. ROMICAT II was designed to test if CCTA done soon after a patient arrives at the ER with a complaint of chest pain could help clinicians diagnose more quickly without putting the patient at increased risk. It found that yes, it could. The prospective, multicenter, randomized, strategy-controlled trial attempted to duplicate as closely as possible the patient population studied in ROMICAT-I. It enrolled 1,000 patients seen at nine hospitals for chest pain of at least 5 minutes duration in the previous 24 hours. All were ages 40 to 74 without a previous history of coronary artery disease or evidence of heart damage on their electrocardiogram (ECG) or blood tests. From this group, 501 were assessed with CCTA and 499 were assessed with standard ER evaluation methods. When the results were analyzed, the average length of hospital stay for the CCTA group was 7.6 hours less than for the group that underwent standard screening procedures alone. The best news was for the patients whose symptoms were not the sign of acute coronary syndrome or another serious condition. Half of the patients in the CCTA group were discharged in 8.6 hours or less without doctors missing a single case of acute coronary syndrome. In contrast, half of the patients in the standard evaluation group were sent home in 26.7 hours or less. Only 10 percent of the standard evaluation group was discharged in 8.6 hours. One thing CCTA did not do even with the shorter hospital stays, however, was reduce health care costs. In the study, costs for both the CCTA group and the standard evaluation group were the same. And, of course, the CCTA group was exposed to greater radiation. What may tip the balance in favor of CCTA, according to the authors, is that new technology now allows CCTA to be done with lower doses of radiation, and a quick ruling out of heart attack is undeniably a big benefit for the patient. "The results from this study should help health care providers and patients make better informed decisions by knowing the risks and potential benefits of using CT scans to more quickly diagnose acute coronary syndrome," said Udo Hoffmann, M.D., M.P.H., the study's principal investigator at Massachusetts General Hospital and Harvard Medical School, Boston, in an NIH press release. "It can be a relief to patients with chest pain to quickly know they are not having a heart attack and that they can spend the night at home, instead of in a hospital bed." The study appears in the July 26 issue of the New England Journal of Medicine. Access it here.