Monday, July 30, 2012


Is there a role for the use of Computerised Tomography angiogram ( CTA or CT angio ), to exclude an acute coronary syndrome? CTA is a means of evaluating the state of your coronary arteries, using Xrays, with contrast injection.  In USA ( as opposed to Malaysia ), Cardiac CT scan machines were initially install in the Emergency room, so that patients with chest poains and suspected heart attacks, could get a scan, and if the scan is negative, the patient could be safely send home, as the negative predictive value of the scan is nearly 100%. In Malaysia, the CT scan machine is freely available and parked in day clinic centers, and used mainly as a tool to " check the heart for blockages". This broad about an increased rate of invasive coronary angiogram, and sometimes even coronary stenting for many borderline lesions. Lets not go there today.
Dr Udo Hoffman, et all of Mass Gen Hospital ( the top hospital in USA ), Boston,  has completed a study called the ROMICAT II ( ROMICAT stands for Rule out MI Computer assisted  ) study. This study was reported in the July 26th issue of the New England Journal of Medicine. They randomised 1,000 patients,who had all presented to the Emergency Department with chest pains, have to receive the CT angio following a ECG, and the other half to rule out in the conventional way of serial ECGs, and cardiac enzymes, and maybe overnight observations. With a 1 montn follow-up, they found that the use of CT angio shorten the waiting time to discharge patient by 7.6 hrs and also lessen the number of patients that needed to be admitted for observation. This was at an increase cost of USD 200 and an increase radiation dose of 11 mSv.
Basically, there was not much advantage in using CT angio in the ER when compared to good old clinical evaluation of serial ECGs and Trop T.
So that although supporters of CT angio will try and view this test positively, saying that there is a role to play, many of us clinicians will view that it is not better that good old bedside medical approach, with less radiation and some cost savings.
When I find the time, I think we should re-visit CT angio  in 2012

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