Abstract 6102: Integration of Non-Contrast Cardiac Computed Tomography and Stress Myocardial Perfusion Imaging in the Emergency Department: Identifying Which Patients with Chest Pain Can be Safely Discharged Home

TL;DRAbstract

Over 5 million emergency department (ED) visits occur annually for evaluation of chest pain. A rapid simple imaging algorithm is needed to identify patients with noncardiac chest pain so as to avoid unnecessary hospital admission. We conducted a prospective trial in 1031 low risk patients (60% women; mean age 54±13 years) admitted through the ED to our chest pain unit who had no prior cardiac history, a nondiagnostic ECG for ischemia, and a normal initial troponin. All patients had stress myocardial perfusion imaging (SPECT) with a coronary artery calcium score (CACS) by noncontrast cardiac computed tomography (CT) within 24 hours. Mean patient follow-up was 7.4±3.3 months. SPECT and CT studies were interpreted independently and the CACS quantified as an Agatston score. The mean TIMI risk score was 1.5±0.7. Cardiac events occurred in 29 patients (2.8%): acute myocardial infarction (N=4) or an acute coronary syndrome (ACS, N=21) during admission; or ACS following hospital discharge (N=4

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