EBCT FOR ACUTE CHEST PAINS

Screening patients with chest pain in the emergency department using electron beam tomography: a follow-up study. Georgiou D, Budoff MJ, Kaufer E, Kennedy JM, Lu B, Brundage BH. Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, USA  J Am Coll Cardiol 2001 Jul; 38(1): 105-10

OBJECTIVES: The high sensitivity of electron beam tomography (EBCT) in the detection of coronary artery calcium (CAC) and obstructive coronary artery disease prompted us to investigate the association between CAC detection and future cardiac events in patients with acute chest pain syndromes requiring hospitalization.

BACKGROUND: Three studies have documented that EBCT is a rapid and efficient screening tool for patients admitted to the emergency department (ED) with chest pain, but there is a paucity of long-term follow-up data on these chest pain patients.

METHODS: We conducted a prospective observational study of 192 patients admitted to the ED of a large tertiary care hospital for chest pain syndromes. Upon admission, patients underwent EBCT scanning in addition to the usual care for chest pain syndromes. During the 17-month enrollment period, 221 patients were scanned (54% men with a mean age of 53 +/- 9 years). Average follow-up was 50 +/- 10 months using chart review.

RESULTS: Fifty-eight patients had coronary events confirmed by a blinded medical record review. The presence of CAC (a total calcium score >0) and increasing score quartiles were strongly related to the occurrence of hard cardiac events including myocardial infarction and death (p < 0.001) and all cardiovascular events (p < 0.001). Stratification by age- and gender-matching further increased the prognostic ability of EBCT (for scores above vs. below the age- and gender-matched CAC scores; odds ratio: 13.1, 95% confidence intervals: 5.62, 35.9).

CONCLUSIONS: These data support previous reports demonstrating that the presence of CAC in a symptomatic cohort is a strong predictor of future cardiac events This study supports the use of EBCT in a symptomatic cohort with prompt discharge of those patients with negative scans. Furthermore, the absence of CAC is associated with a very low risk of future cardiac risk events in this population over the subsequent seven years (annual event rate <1%).