CT Scans Can Spot Heart Trouble Fast

MONDAY, March 26 (HealthDay News) — 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 new 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.

“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 Dr. Judd
Hollander, clinical research director of the department of emergency
medicine at the University of Pennsylvania, in Philadelphia.

“We can now answer the questions faster, and let people go home
sooner,” he said.

Using the CT scan is faster, 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.

“And an EKG only shows if you are having the big one,” Hollander added.
“So, if it’s negative it doesn’t tell you if you are having a smaller
heart attack, and two-thirds of heart attacks will have an EKG that’s not
diagnostic.”

For every 100 patients who go to an ER with chest pain, only 10 or 15
have cardiac disease, Hollander said. “The other 90 percent end up with
nothing serious,” he added.

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.

The findings were to be presented Monday at the American College of
Cardiology’s annual meeting in Chicago. They will also be published
simultaneously in the New England Journal of Medicine.

For the study, 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 percent
versus 23 percent, the researchers found.

Those who received scans spent less time in the hospital and had heart
problems diagnosed faster.

Scans are also cost-effective, 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.

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, they 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.

Commenting on the study, Dr. Gregg Fonarow, director of the
Ahmanson-UCLA Cardiomyopathy Center and co-director of the UCLA
Preventative Cardiology Program, said that “there are 8 million men and
women that present to emergency medical centers with chest pain each
year.”

There has been great interest in developing strategies to more
efficiently evaluate these patients and identify which ones can be safely
discharged, he said.

The trial demonstrated that these scans may be useful to screen low- to
moderate-risk patients, Fonarow 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, 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 do not
come back as quickly as a CT scan.

More information

For more on heart attacks, visit the American Heart Association.

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