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Comparison Between Anatomical and Functional Imaging Modalities for Evaluation of Chest Pain in the Emergency Department.

解剖学和功能成像模式评估急诊科胸痛的比较。

  • 影响因子:2.86
  • DOI:10.1016/j.amjcard.2020.03.024
  • 作者列表:"Kargoli F","Levsky J","Bulcha N","Mustehsan MH","Brown-Manhertz D","Furlani A","Polanco D","Mizrachi S","Makkiya M","Golive A","Haramati L","Taub C","Garcia MJ
  • 发表时间:2020-06-15
Abstract

:Evaluation of chest pain in the emergency department (ED) frequently employs a noninvasive strategy, including coronary computed tomography angiography (CCTA), stress echocardiography (SE), or myocardial perfusion imaging (MPI). We sought to report the real-world experience of utilizing CCTA compared with SE and MPI at an urban hospital ED. We conducted a retrospective cohort study of consecutively enrolled patients presenting with chest pain who had normal or nondiagnostic electrocardiogram (ECG), negative initial troponin-T, at least intermediate risk based on modified Diamond-Forrester criteria, and who underwent CCTA, SE, or MPI based on their individual test eligibility criteria. The primary outcome was ED discharge time. Secondary outcomes included test utilization and 30-days rehospitalization rates. The 2,143 patients who were included (mean age was 56 ± 12 years; 55% women) utilization rate (test performed/eligible) was lower for CCTA (n = 354/1,329) and MPI (n = 530/1,435) compared with SE (n = 1,259/1,650), p <0.001. Mean ED discharge times for both CCTA and SE were 12.5 ± 7.4 versus 16 ± 7.3 hours for MPI (p <0.0001). Patients with SE and CCTA were less likely to undergo coronary angiography (29%, 25%, vs 52% for MPI). There was a 1% cardiac-related 30-days rehospitalization rate in the CCTA group versus 1% in SE and 3% in the MPI group (p <0.01). In conclusion, CCTA and SE were associated with faster ED discharge and lower frequency of diagnostic coronary angiography. Notwithstanding its clinical utility, CCTA was underutilized at our large urban ED setting.

摘要

: 急诊科 (ED) 中胸痛的评估经常采用无创策略,包括冠状动脉计算机断层扫描血管造影 (CCTA) 、负荷超声心动图 (SE) 或心肌灌注成像 (MPI)。我们试图报告在城市医院ED中使用CCTA与SE和MPI相比的真实世界经验。我们对连续入选的胸痛患者进行了一项回顾性队列研究,这些患者心电图 (ECG) 正常或非诊断性,初始肌钙蛋白-T阴性,根据改良的Diamond-Forrester标准至少有中等风险,并根据其个体测试资格标准接受了CCTA,SE或MPI.主要结局为ED出院时间。次要结局包括试验使用率和30天再住院率.纳入的2,143例患者 (平均年龄为56 ± 12岁; 55% 例女性) 与SE (n = 354/1/329) 相比,CCTA (n = 530/1,435) 和MPI (n = 1,259,1,650) 的使用率 (进行/符合条件的测试) 较低,p <0.001。CCTA和SE的平均ED放电时间分别为12.5 ± 7.4和MPI的16 ± 7.3小时 (p <0.0001)。SE和CCTA患者不太可能接受冠状动脉造影 (29%,25%,与MPI的52% 相比)。CCTA组心脏相关30天再住院率为1%,SE组为1%,MPI组为3% (p <0.01)。总之,CCTA和SE与更快的ED放电和更低的诊断性冠状动脉造影频率相关。尽管其临床实用性,但CCTA在我们的大型城市ED环境中未被充分利用。

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影响因子:2.41
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关键词: 暂无
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影响因子:1.67
发表时间:2020-01-01
DOI:10.2174/1573403X15666190513105231
作者列表:["Dev M","Sharma M","Rana N"]

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心脏影像技术方向

心脏结构和心脏血流的可视化,用于诊断评估或通过内窥镜、放射性核素成像等技术来指导心脏手术。

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