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CT angiography “Triple Rule Out” (TRO) provides the ability to simultaneously and rapidly evaluate for significant coronary artery disease (CAD), pulmonary embolism (PE), and aortic disease (AD) in patients with acute chest pain. Although feasible, the “real world” application of TRO is not well established. We sought to evaluate the diagnostic yield of TRO compared to coronary CT angiography (CCTA) in a large, statewide, multicenter registry.
Patients undergoing TRO or CCTA at 53 Michigan institutions participating in the ACIC were included. Demographics and CCTA findings were compared among the two groups. The primary outcome of diagnostic yield was defined by obstructive CAD (>50% stenosis), PE, or AD; secondary outcomes of radiation dose, contrast volume, and CT image quality.
From July 2007 to May 2012 32,266 patients (1,900 TRO and 30,366 CCTA) were enrolled in ACIC. Patients in the TRO group were younger and more often female with lower frequencies of CAD risk factors including diabetes, hypertension, hyperlipidemia, and family history. The overall diagnostic yield for TRO was 19.6% compared to 24.4% in CCTA(P <0.0001); predominately for obstructive CAD(18.6% in TRO and 23.5% in CCTA, P<0.0001). PE was diagnosed in 0.5% of TRO and 0.2% of CCTA (P=0.006) and AD in 1.6% of TRO and 1.3% of CCTA (P=0.74). TRO was associated with a higher median radiation dose (10.6mSv (6.7, 16.2) vs. 9.2 mSv, (5.4, 15.5) p<0.0001) and contrast volume (118+/-21ml vs. 94+/-17ml; P<0.0001). Higher frequencies of poor/uninterpretable image quality were noted for TRO (9.7% vs. 7.5%, P=0.0005)
In this large real-world study, TRO was associated with lower overall diagnostic yield, higher radiation exposure, larger contrast volumes, and poorer image quality. This data suggests that although feasible, clinical criteria for TRO use and appropriateness must be further defined.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Imaging: CT/Multimodality I
Abstract Category: 20. Imaging: CT/Multimodality
Presentation Number: 1140-330
- 2013 American College of Cardiology Foundation