ROCHESTER, MINN. -- A Mayo Clinic study published in Annals of Emergency Medicine finds electron-beam computed tomography (EBCT), a type of CAT scan, quickly detects coronary artery calcification in emergency room patients with chest pain. If the scan shows no calcification, the patient is at low risk of having a heart attack.
"A negative EBCT allows doctors to safely send patients home without further observation in a chest pain unit or admittance to the hospital," says Dr. Dennis Laudon, chief investigator of the study. "According to study findings, EBCT is an efficient, cost-effective screening tool for patients with chest pain, normal initial test results and no history of coronary artery disease.
"Determining the cause of chest pain in ER patients is often difficult," adds Dr. Laudon. "Until this point there hasn't been an effective test to tell us if the heart is involved or if the pain is caused by something else. Now we can safely send patients home without admitting them to a chest pain unit for further tests and observation. And that saves the patients worry, time and money."
More than 5 million people with chest pain are admitted to emergency departments each year. Of those patients, 1.5 million actually suffer a heart attack or have angina, a condition in which the heart muscle does not get an adequate supply of blood or oxygen.
"Doctors often recommend hospital admission for patients whose cause of chest pain is unclear," Dr. Laudon notes. "This practice results in an estimated cost of $10 billion to $13 billion per year. Our study shows EBCT, a $420 test that takes a frozen image of the heart, can tell doctors whether or not patients are at acute risk for heart attack."
Researchers studied 105 patients admitted to the emergency department from December 1995 to October 1997. All participants underwent EBCT tests. Of those patients, 100 had additional standard evaluations, including combinations of treadmill exercise tests, coronary angiography, radionuclide testing and echocardiography. Results of EBCT were negative for 53 of the 100 patients. The negative findings remained the same during a four-month follow-up period.
"For the subset of chest pain patients whose blood tests and electrocardiographs are normal, a negative EBCT test can tell us we can send them home," Dr. Laudon says. "The test is 20 times faster than a normal CAT scan, and it is noninvasive -- no needle, no oral contrast materials. The only risk to the patient is a small dose of radiation similar to that of a conventional chest CT scan."
Dr. Laudon says a larger scale study is needed to confirm results. EBCT is available at a few sites in the midwest, including Mayo Clinic, Iowa City and Madison, Wis.
Journal
Annals of Emergency Medicine