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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThe use of coronary computed tomography for screening patients that present in emergency departments (EDs) with acute chest pain shortens length of stay compared with standard ED evaluation, according to the Rule Out Myocardial Infarction Using Computer-Assisted Tomography II Trial [ROMICAT II; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01084239\u0026amp;atom=%2Fspmdc%2F12%2F4%2F16.atom\u0022\u003ENCT01084239\u003C\/a\u003E].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EEmergency Radiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERadiography\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiac Imaging Techniques\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EImaging Modalities\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EThe use of coronary computed tomography (CCTA) for screening patients that present in emergency departments (EDs) with acute chest pain shortens length of stay (LOS) compared with standard ED evaluation, according to the Rule Out Myocardial Infarction Using Computer\u2013Assisted Tomography II Trial [ROMICAT II; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01084239\u0026amp;atom=%2Fspmdc%2F12%2F4%2F16.atom\u0022\u003ENCT01084239\u003C\/a\u003E]. ROMICAT II also showed that use of CCTA early into an ED evaluation improved clinical decision\u2013making for ED triage compared with the standard approach. Udo Hoffmann, MD, MPH, Massachusetts General Hospital, Boston, Massachusetts, USA, presented results from the study.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe first prospective, multicenter, randomized, controlled trial to compare CCTA screening with standard ED evaluation for patients with chest pain that is suggestive of acute coronary syndrome (ACS), ROMICAT II randomized 1000 patients at 9 sites in a 1:1 ratio to either CCTA screening or standard care. The hypothesis was that CCTA may enable earlier but safe triage, reducing LOS and hospital admissions compared with standard ED evaluation. The primary endpoint was LOS.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EInclusion criteria included chest pain or equivalent symptoms that were suggestive of ACS; patient age between 40 and 74 years; the ability of the patient to hold their breath for at least 10 seconds; and sinus rhythm. Baseline characteristics were similar between the two groups. The main complaint at presentation was anginal pain or equivalent (88.6% in the CCTA group, n=501; 90.6% in the standard ED evaluation group, n=499).\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EAverage time to diagnosis was 10.4 hours in the CCTA group versus 18.7 hours in the standard ED evaluation group (p=0.0001). At discharge, 8.6% of CCTA patients versus 6.4% of those patients in the standard care group had ACS. Agreement between site and independent adjudication for discharge diagnosis was 96.5% (kappa 0.9). There were no missed diagnoses of ACS in either group.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThe mean LOS for all CCTA patients was 23.2\u00b137.0 hours versus 30.8\u00b128.0 hours (p=0.0002) for the standard care group. For those without a final diagnosis of ACS, mean LOS was on average 10 hours shorter for the CCTA group (17.2\u00b124.6 vs 27.2\u00b119.5 hours; p\u0026lt;0.0001; \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/14000\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/14000\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14000\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003ELOS by Diagnosis.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-10\u0022\u003EThe differences in patient disposition were significant, with direct ED discharge of 46.7% for the CCTA group versus 12.4% for the controls (p\u0026lt;0.001). Observation unit admission was 26.6% in the CCTA group versus 53.7% of controls (p=0.001). The respective figures for admission to the hospital and leaving against medical advice were both lower in the CCTA group\u201425.4% versus 31.7% and 1.3% versus 2.2%, respectively (both p=0.001).\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EMajor adverse events (death, myocardial infarction, unstable angina, urgent revascularization) within 30 days were similar in both groups (0.4 and 1.0, respectively; p=0.37). There was higher cumulative radiation exposure in the CCTA group (14 mSv vs 5.3 mSv; p\u0026lt;0.0001).\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EHospital billing data demonstrated no difference in mean total cost ($4004 vs $3828; p=0.72). However, the CCTA\u2013first approach was associated with reduced mean ED costs of $2053\u00b11076 versus $2532\u00b11346 for the standard evaluation group (p\u0026lt;0.0001) that were partially offset by a higher mean hospital cost ($1950 vs $1297; p=0.17) with CCTA. Of note, use of a CCTA\u2013first approach was associated with an increased use of conventional coronary angiography (12% vs 8%; p=0.04) and a numerically greater number of coronary revascularization procedures (6.4% vs 4.2%; p=0.16).\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EOverall, ROMICAT II shows that CCTA is feasible in the ED for patients who present with suspected ACS and reduces both LOS and time to diagnosis. There was no significant increase in total cost associated with this approach; however, there was increased radiation exposure. Further studies are necessary to see if the use of CCTA in the ED has an effect on clinical outcomes.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/4\/16.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznhc1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nznhc1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}