Evaluation of stable chest pain following emergency department presentation: Impact of first-line cardiac computed tomography diagnostic strategy in an Australian setting


Objective: International guidelines provide increasing support for computed tomography coronary angiography (CTCA) in investigating chest pain. A pathway utilising CTCA first-line for outpatient stable chest pain evaluation was implemented in an Australian ED.

Methods: In pre-post design, the impact of the pathway was prospectively assessed over 6 months (August2021 to January 2022) and compared with a 6-month pre-implementation group (February 2021 to July 2021).CTCA was recommended first-line in suspected stable cardiac chest pain, followed by chest pain clinic review. Predefined criteria were provided recommending functional testing in select patients. The impact of CTCA versus functional testing was evaluated. Data were obtained from digital medical records.

Results: Three hundred and fifteen patients were included, 143 pre-implementation and 172 post-implementation. Characteristics were similar except age (pre-implementation:58.9 12.0vspost-implementation:62.8 12.3 years, P=0.004). Path-way-guided management resulted in higher first-line CTCA (73.3%vs46.2%,P< 0.001), lower functional testing (30.2%vs56.6%,P<0.001)

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