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Purpose: We sought to determine the long-term safety of a novel diagnostic approach that utilised coronary computed tomography angiography (CTA) to assess patients presenting to the Emergency Department (ED) with low-to-intermediate risk chest pain.

Methods: We prospectively evaluated 585 consecutive patients who presented to ED between September 2008 and June 2011 with low-to-intermediate risk (TIMI 0–4) ischaemic-type chest pain who were evaluated with 320-row CTA after normal electrocardiogram and negative single (284 patients) or serial troponin (301 patients) depending on time of presentation. Patients with previous significant coronary stenoses or revascularisation were excluded. Patients undergoing CTA after single troponin who had no plaque on CTA were discharged without serial troponin and no further investigation following discharge. Patients undergoing CTA after single troponin who had any plaque and up to mild stenoses were discharged after repeat troponin with no further investigation following discharge. Patients with moderate stenoses were discharged with outpatient stress echocardiography. Patients with severe stenoses were admitted for invasive angiography. Discharged patients were contacted by telephone and medical records reviewed to determine safety outcomes.

Results: Mean age was 58±11 years (58% male). 93/284 patients (33%) undergoing CTA after single troponin had no plaque and were discharged after only a single troponin. 486/585 patients overall (83%) had no plaque or mild stenoses on CTA and were discharged with no further investigation, 24/585 (4%) had moderate stenoses on CTA and were discharged with outpatient stress echocardiography and 74/585 (13%) had severe stenoses on CTA and were admitted for invasive angiography. At median 47.1-month follow-up (range 20-53 months), there had been five chest pain readmissions (1%, 95% confidence interval 0.4-2.3%), no revsascularisation procedures, no myocardial infarctions and no deaths (95% confidence interval 0-0.8%). Follow-up was 99% complete.

Conclusion: Triaging low-to-intermediate risk patients with a CTA-guided strategy is safe at long-term follow-up, including patients discharged after a single negative troponin.

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The European Society of Cardiology
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