MIA 2012: Hoffmann U et al. Coronary CT angiography versus standard evaluation in acute chest pain. N Engl J Med. 2012 Jul 26;36
Posted Jan 01 2013 4:19pm
ROMICAT-II study: Coronary CT angiography (CCTA) is a safe and faster diagnostic strategy than the standard evaluation of low-to-intermediate risk chest pain patients. CCTA, however, results in higher radiation exposure and more downstream testing.
Why It’s Important for Emergency Medicine:
While the mantra in medicine is to “Do no harm”, the trend in Emergency Medicine seems simply just “Do more”.
It should come as no surprise that we can get a CT scan faster than a stress test. And as well, it should be of no surprise that patients randomized to the CCTA arm are dispositioned sooner than patient evaluated by the “standard” method (which meant a stress test in 74%).
The interesting point in this study (and other studies before this) is that neitherCCTA nor stress test mattered; less than 1% of the entire cohort had a myocardial infarction, and no one died! So why can’t we sensibly defer to outpatient follow-up within a few weeks?
It’s time we go back to another truism: Less is more.
Patients who received CCTA went home 7.6 hrs sooner than patients evaluated traditionally (23.2 hrs v 30.8 hrs).
More CCTA patients were discharged directly from the ED (47% v 12%).
CCTA patients underwent more tests (≥ 2 tests, 23% v 11%).
Cumulative radiation exposure higher in CCTA (13.9 mSV v 4.7 mSV)