131 Tomography angiography in acute coronary syndrom: The TIACS study

BackgroundTriage of chest pain patients in the emergency department remains challenging. Multi-slice computed tomography angiography (CTA) has a high negative predictive value for exclusion of coronary artery stenosis.Objectivesto assess mid-term outcomes in patients with low to intermediate likelihood of acute coronary syndrome (ACS) who underwent Multi-slice CTA.Methodsprospective observational single-center cohort study in chest pain patients with normal troponin and non ischemic electrocardiogram. Patients with normal coronary 64-slice CTA or with stenosis less than 50% luminal narrowing were discharged from the emergency unit. End points were coronary artery revascularizations during index hospitalization and major adverse cardiac events (MACE) during follow-up.ResultsAmong 123 patients (mean age 51 +/− 13 years, 70% men), 60 were free of coronary artery disease (CAD) according to CTA (49%). Twentysix (21%) had non obstructive disease and 29 (24%) had inconclusive or positive computed tomography for significant stenosis. Mean radiation exposure was 21 +/− 1mSv. Twenty-seven patients had invasive coronary angiography. Ten patients (8%) needed coronary artery revascularizations during index hospitalization. Nine had coronary angioplasty and one patient had bypass surgery with four grafts.During the mean follow-up of 14+/-4 months, no patient suffered from MACE including patients who had coronary artery revascularizations during index hospitalization. Negative predictive value for MACE was 100% (95%confident interval 98–100%).ConclusionsSeventy-three percent of patients with acute chest pain and low to intermediate likelihood of ACS were free or had non-significant CAD according to CTA and no MACE during a 14 month follow-up period. Given the large number of such patients, early coronary CTA may significantly improve patients’ management in the emergency department. Reduction of radiation exposure will facilitate acceptance in clinical practice