Hello all, wishing you the best in 2022!
Some good news here… our team is fortunate enough to have ready access to cardiac CT angiography for emergency department chest pain patients, along with cardiology and radiology support!
For patients less than 75 years old without prior ACS or revascularization, without severe renal disease and in normal sinus rhythm, who do not have ischemic EKGs or worrisome troponin elevations (ie patients who would previously have obtained an exercise stress test or nuclear scan) we generally obtain cardiac CT angiography.
Historically, 10% of patients have an occlusion greater than 50%. However, for patients with less than 50% occlusion, we have found that the 7.5 year outcomes (I know, I know, it’s an unusual number) are excellent: Less than 0.5% of such patients will have cardiovascular death or revascularization by that point. Few other tests in medicine, let alone emergency medicine, provide this warranty.
So if you see a patient with a “negative” CT a few years down the road, very unlikely to require extensive investigations!
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