Jefferson Study Evaluates “Triple Rule-Out” CT Scan for Acute Coronary Syndrome
Chest
pain is the second most common complaint when patients go to the
emergency room, accounting for six million visits annually.
Determining the cause of patients’ symptoms whether it be a heart
attack or some other life-threatening entity like a blood clot in the
lungs is challenging since the symptoms often overlap. Thomas
Jefferson University Hospital is at the forefront of institutions
evaluating a “triple rule-out” protocol with coronary computed
tomographic angiography (CCTA) for low-to-moderate risk patients
presenting with symptoms suspicious for acute coronary syndrome (ACS).
The “triple rule-out” CCTA provides a non-invasive, rapid and accurate
approach for the proper diagnosis or exclusion of ACS.
Results from the first 200 emergency room patients evaluated with “triple rule-out” CCTA at Jefferson – available online now(www.rsna.org) and set to be published in the August issue of Radiology –
show that the triple scan, used to evaluate coronary disease, pulmonary
embolism, aortic dissection, may expedite care of patients who come to
the emergency department with symptoms of a heart attack. The triple
rule-out protocol showed that 76 percent of the patients with symptoms
mimicking heart disease were not caused by ACS. Eleven percent of
patients had a non-cardiac cause of their symptoms which included some
life-threatening diagnoses such as pulmonary embolism and aortic
dissection. With regards to coronary artery disease, five percent of
patients had severe disease and six percent had moderate disease that
was immediately recognized by CCTA. These results demonstrate the
potential of the “triple rule-out” CCTA to reduce costs, limit the
amount of inpatient observation and evaluation for suspected ACS, and
allow better treatment with more time-sensitive diagnoses.
“Triple
rule-out coronary CT angiography provides noninvasive visualization of
coronary arteries with simultaneous evaluation of the pulmonary
arteries, thoracic aorta, and other intra-thoracic structures that
might explain signs and symptoms that overlap with ACS,” said Ethan
Halpern, M.D. director of Cardiac CT at Jefferson Medical College of
Thomas Jefferson University, and co-author of the study. “Furthermore,
the examination time and radiation exposure are less than that required
for a conventional nuclear stress test which is most often used to
evaluate these patients.”
“Standard
medical practice tends to be very cautious when a patient presents with
symptoms suggesting ACS by performing a battery of tests and sometimes
lengthy hospital stays to determine the source of pain,” adds Kevin
Takakuwa, M.D., assistant professor, Department of
Emergency Medicine at Jefferson Medical College of Thomas Jefferson
University, and co-author of the study. “This traditional approach in
diagnosis wastes millions of dollars in unnecessary health care costs,
but if we can find a way to rapidly rule out ACS as early as possible
and more accurately diagnose patients’ problems we can potentially save
millions of dollars and a lot of time.”
Triple
rule-out using coronary CT scans helped to appropriately triage
patients who presented to the Jefferson Chest Pain Center, and allowed
them to be discharged from the hospital earlier, with no adverse events
at thirty day follow-up. This protocol to evaluate both coronary and
non-coronary disease using the triple rule-out CCTA provides a new cost
effective and streamlined alternative diagnostic evaluation process for
potential ACS patients.
Media Only Contact:
Ed Federico
Thomas Jefferson University Hospital
Phone: (215) 955-6300
Published: 7/18/2008