| CHICAGO, March 26
CHICAGO, March 26 Using a heart scan in the
emergency room to rule out heart attacks and other problems in
low-risk patients with chest pain can save hospitals billions of
dollars, researchers said on Monday.
Chest pain is the most common reason people visit the
emergency room, yet 85 percent of the time, it is not related to
a heart problem.
The usual course of events when a patient with chest pain
checks into the emergency room starts with an electrocardiogram,
or EKG, a noninvasive test that checks for problems with the
electrical activity of the heart.
If the EKG does not show evidence of a heart attack, the
patient usually is admitted to the hospital for a series of
tests to rule out heart problems.
The patient then gets blood tests over 12 to 24 hours to
check for high levels of a certain enzyme that suggests there
was damage to the heart muscle. If those tests are also
negative, then the patient takes a stress test -- with or
without imaging -- to look for reduced blood flow to the heart
due to a blockage.
If results are positive, the patient is likely to get a
cardiac catheterization, an invasive procedure that involves
threading a catheter, or a thin tube, into the heart. The
procedure requires the use of contrast dye.
A coronary computed tomography angiogram, also known as a
coronary CT scan, is a test used to diagnose coronary artery
disease, the narrowing of the small blood vessels that supply
blood to the heart that can lead to chest pain and heart attack.
It is usually used after the patient undergoes EKG, blood
tests and nuclear stress tests.
"Our idea is to use coronary CT scans as a triage tool for
patients coming into ER," said Dr. Harold Litt, chief of
cardiovascular imaging in the Radiology at the Perelman School
of Medicine at the University of Pennsylvania and lead
researcher on a study presented at the Scientific Sessions of
the American College of Cardiology meeting in Chicago.
The scan works with an intravenous iodinated contrast dye to
produce an image of the coronary arteries. Such dyes can cause
kidney failure, so the test should be used only if a patient has
normal kidney function, Litt said.
DIFFERENT TEST, SIMILAR RISK
The 2.5-year study of nearly 1,400 adults -- about evenly
divided between men and women -- in five centers in Pennsylvania
and North Carolina was published in the New England Journal of
Medicine. It showed that the rate of heart attack and
heart-related deaths 30 days after discharge with a negative CT
scan was less than 1 percent.
That meets the standard for emergency rooms discharging a
person with chest pain.
"I think the data is very convincing," Litt said in a
telephone interview. "There have been smaller studies like this,
but this is the first one that's large enough to show ... that
is safe to send someone home after a CT scan."
Of 640 patients who had negative CT scans, there were no
heart attacks or cardiac deaths after 30 days, according to the
study, which the Pennsylvania Department of Health paid for with
U.S. tobacco settlement funds.
Some 50 percent of patients who got a CT scan in the
emergency room were discharged directly from there, compared
with 23 percent of those who received traditional care. The CT
scan group were in the hospital for an average of 18 hours,
compared with 25 hours for the traditional care group.
The CT scan is also an attractive tool because it can rule
out coronary blockages at about half the cost of the leading
competing test, a nuclear stress test, which uses more
radiation, he said.
"We think most of the cost saving is in faster discharges,"
Litt said. "ER crowding is a major issue. All patients do worse
when there's crowding."
Doing CT scans in emergency rooms saved $2,500 per patient,
according to a study based on 2006-2007 data from the Hospital
of the University of Pennsylvania.
"If you have a history (of heart problems), a CT would not
be the right test for you," Litt said, noting that two-thirds of
patients who go the ER with chest pain are low- to
intermediate-risk and therefore would be eligible for a CT scan.
The other one-third would be deemed high risk and ineligible.
He said 9 percent of patients who got the CT scan were
diagnosed with coronary artery disease, compared with only 3.5
percent of those who received traditional care.
(Editing by Michele Gershberg)