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CLINICAL STUDY

Screening patients with chest pain in the emergency department using electron beam tomography: a follow-up study

Demetrios Georgiou, MD, FACC^a, Matthew J. Budoff, MD, FACC, Eric Kaufer, MD, John M. Kennedy, MD, Bin Lu, MD and Bruce H. Brundage, MD, FACC

^a Department of Medicine, Division of Cardiology, Columbia University, College of Physicians and Surgeons, New York, New York, USA
Department of Medicine, Division of Cardiology, Harbor-UCLA Research and Education Institute, Torrance, California, USA
Bend Memorial Clinic, Bend, Oregon, USA

Manuscript received January 10, 2001; revised manuscript received March 27, 2001, accepted April 5, 2001.

Reprint requests and correspondence: Dr. Matthew Budoff, Saint John’s Cardiovascular Research Center, Harbor-UCLA Medical Center, 1124 West Carson Street, RB-2, Torrance, California 90502
Budoff{at}flash.net

OBJECTIVES

The high sensitivity of electron beam tomography (EBT) in the detection of coronary artery calcium (CAC) and obstructive coronary artery disease prompted us to investigate the association between CAC detection and future cardiac events in patients with acute chest pain syndromes requiring hospitalization.

BACKGROUND

Three studies have documented that EBT is a rapid and efficient screening tool for patients admitted to the emergency department (ED) with chest pain, but there is a paucity of long-term follow-up data on these chest pain patients.

METHODS

We conducted a prospective observational study of 192 patients admitted to the ED of a large tertiary care hospital for chest pain syndromes. Upon admission, patients underwent EBT scanning in addition to the usual care for chest pain syndromes. During the 17-month enrollment period, 221 patients were scanned (54% men with a mean age of 53 ± 9 years). Average follow-up was 50 ± 10 months using chart review.

RESULTS

Fifty-eight patients had coronary events confirmed by a blinded medical record review. The presence of CAC (a total calcium score >0) and increasing score quartiles were strongly related to the occurrence of hard cardiac events including myocardial infarction and death (p < 0.001) and all cardiovascular events (p < 0.001). Stratification by age- and gender-matching further increased the prognostic ability of EBT (for scores above vs. below the age- and gender-matched CAC scores; odds ratio: 13.1, 95% confidence intervals: 5.62, 35.9).

CONCLUSIONS

These data support previous reports demonstrating that the presence of CAC in a symptomatic cohort is a strong predictor of future cardiac events. This study supports the use of EBT in a symptomatic cohort with prompt discharge of those patients with negative scans. Furthermore, the absence of CAC is associated with a very low risk of future cardiac risk events in this population over the subsequent seven years (annual event rate <1%).

Abbreviations and Acronyms   CAC = coronary artery calcium   CI = confidence interval   CS = calcium score   EBT = electron beam tomography   ECG = electrocardiogram   ED = emergency department   Hu = Hounsfield unit   MI = myocardial infarction   OR = odds ratio

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