Most people who go to the emergency room with chest pain aren't having a heart attack, but it can take hours or days to make a definitive diagnosis.
However, a recent study finds that a special kind of CT scan given in the emergency room seems to identify a heart attack faster than traditional methods, so patients can be sent home safely sooner.
Chest pain is one of the most common reasons people go to the emergency room in the United States, accounting for as many as 8 million visits each year, at a cost of several billion dollars, the researchers noted.
"You can go to an emergency department with chest pain, be concerned it might be a heart attack-get a CT scan, like we do for everything else in the emergency department-and we can say it's not your heart and you can go home, within a couple of hours," said researcher Judd Hollander, MD, clinical research director of the department of emergency medicine at the University of Pennsylvania, Philadelphia.
Using the CT scan is faster than traditional methods, Dr. Hollander said, noting it can take 25 hours to get the results of blood tests that indicate whether a patient has had a heart attack.
An EKG (electrocardiogram) may accurately show larger heart attacks, but it can miss smaller ones, according to Dr. Hollander. "Two-thirds of heart attacks will have an EKG that's not diagnostic," he added.
For every 100 patients who go to an ER with chest pain, only 10 or 15 have cardiac disease specific to heart failure, Dr. Hollander said. Many of those who don't have heart disease have minor problems such as bad indigestion. In addition, ERs are busy and crowded, and this is a way to move patients out faster and increase the ability to see more patients sooner, he said.
For the study, Dr. Hollander's team randomly assigned more than 1,300 patients with chest pain, but no previous history of heart disease or risk factors such as high blood pressure or diabetes, to CT scans or regular care.
The scans generate three-dimensional images of the heart and the blood vessels surrounding it, the researchers noted.
Among those with a normal scan, none died or had a heart attack within a month after being seen in the ER. In addition, more of these patients were sent home than those who received usual care—about 50% versus 23%, the researchers found.
Those who received scans spent less time in the hospital and had heart problems diagnosed faster.
The findings were published in the New England Journal of Medicine.
CT Scans Save Money
Scans are also cost-effective, Dr. Hollander said. The tests, which are like a standard CT scan, cost about $1,500. Patients who have a normal scan can be sent home within a few hours. A patient who is admitted to the hospital can run up bills of more than $4,000 for stress tests and monitoring alone, the researchers noted.
Many patients with chest pain are suffering from anxiety, pneumonia or indigestion that can cause the same symptoms as a heart attack, the researchers explained. Yet, more than half of patients with chest pain are admitted to the hospital for observation or testing such as cardiac catheterization or a stress test.
What Experts Say
Commenting on the study, Gregg Fonarow, MD, director of the Ahmanson-UCLA Cardiomyopathy Center and codirector of the UCLA Preventative Cardiology Program, said that the trial demonstrated that these scans may be useful in screening low-to moderate-risk patients.
There has been great interest in developing strategies that efficiently evaluate these patients and identify which ones can be safely discharged, he said.
"However, further studies are needed to evaluate the cost-effectiveness of this strategy and how it compares to protocols using high-sensitivity troponin tests," he added.
A troponin test measures the levels of one of two proteins, troponin T or troponin I, in blood, Dr. Fonarow explained. These proteins are released when the heart has been damaged, such as during a heart attack. However, this test is usually repeated over 12 to 16 hours, so the results are not determined as quickly as a CT scan.