期刊
NEW ENGLAND JOURNAL OF MEDICINE
卷 366, 期 15, 页码 1393-1403出版社
MASSACHUSETTS MEDICAL SOC
DOI: 10.1056/NEJMoa1201163
关键词
-
资金
- Commonwealth of Pennsylvania Department of Health
- American College of Radiology Imaging Network Foundation
- Medrad-Bayer
- Siemens Medical Solutions
- Wilex
- Mela Sciences
- Endocyte
- BioMimetic Therapeutics
- Radiological Society of North America
- Heartscape Technologies
- BreathQuant Medical
- Johnson Johnson-Scios
- GlaxoSmithKline
- EKR Therapeutics
- 3M
- Dyax
- Sanofi-Aventis
- Society of Chest Pain Centers
- Alere
- Brahms
- Nanosphere
- Abbott Laboratories
- Bristol-Myers Squibb
BACKGROUND Admission rates among patients presenting to emergency departments with possible acute coronary syndromes are high, although for most of these patients, the symptoms are ultimately found not to have a cardiac cause. Coronary computed tomographic angiography (CCTA) has a very high negative predictive value for the detection of coronary disease, but its usefulness in determining whether discharge of patients from the emergency department is safe is not well established. METHODS We randomly assigned low-to-intermediate-risk patients presenting with possible acute coronary syndromes, in a 2: 1 ratio, to undergo CCTA or to receive traditional care. Patients were enrolled at five centers in the United States. Patients older than 30 years of age with a Thrombolysis in Myocardial Infarction risk score of 0 to 2 and signs or symptoms warranting admission or testing were eligible. The primary outcome was safety, assessed in the subgroup of patients with a negative CCTA examination, with safety defined as the absence of myocardial infarction and cardiac death during the first 30 days after presentation. RESULTS We enrolled 1370 subjects: 908 in the CCTA group and 462 in the group receiving traditional care. The baseline characteristics were similar in the two groups. Of 640 patients with a negative CCTA examination, none died or had a myocardial infarction within 30 days (0%; 95% confidence interval [CI], 0 to 0.57). As compared with patients receiving traditional care, patients in the CCTA group had a higher rate of discharge from the emergency department (49.6% vs. 22.7%; difference, 26.8 percentage points; 95% CI, 21.4 to 32.2), a shorter length of stay (median, 18.0 hours vs. 24.8 hours; P<0.001), and a higher rate of detection of coronary disease (9.0% vs. 3.5%; difference, 5.6 percentage points; 95% CI, 0 to 11.2). There was one serious adverse event in each group. CONCLUSIONS A CCTA-based strategy for low-to-intermediate-risk patients presenting with a possible acute coronary syndrome appears to allow the safe, expedited discharge from the emergency department of many patients who would otherwise be admitted. (Funded by the Commonwealth of Pennsylvania Department of Health and the American College of Radiology Imaging Network Foundation; ClinicalTrials.gov number, NCT00933400.)
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据