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Real-World Utilization of Cardiac Computed Tomography for Acute Cardiovascular Evaluation in the Emergency Department
Session:
Sessão de Posters 28 - Do diagnóstico à decisão: cuidados orientados por imagem na era moderna
Speaker:
Inês Rodrigues
Congress:
CPC 2026
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.2 Computed Tomography
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Inês Arrobas Rodrigues; Inês Neves; António Gonçalves; Leonor Moura; Francisco Sousa; Francisca Nunes; Marta Almeida; Diogo Ferreira; Fábio Nunes; Rita Faria; Nuno Ferreira; Ricardo Fontes-Carvalho
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background and aim</strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Cardiac computed tomography (CCT) is established for evaluating obstructive coronary artery disease (CAD) in patients with low to moderate pre-test probability. However, its utility in the emergency department (ED) extends to broader cardiovascular assessment. The aim of this study was to review the clinical indications and impact of CCT performed in the ED of our centre.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">All patients admitted to the ED who underwent urgent CCT between January 2020 and December 2024 were included. A descriptive analysis of CCT indications was conducted. Patients assessed for suspected CAD were further evaluated regarding ED diagnosis and clinical outcomes during follow-up (FU).</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Over a median FU of 1070 days (IQR 556-1401), 210 patients underwent urgent CCT. Coronary CT angiography (CCTA) was mainly performed in patients with chest pain to exclude obstructive CAD (80%), acute aortic syndrome (13%) and pulmonary embolism (9.5%). A triple-rule-out strategy was used in 8% of cases, and dual-energy protocol in 2% when CAD was excluded but diagnostic uncertainty persisted. CCT was also used to guide pericardiocentesis (12.4%), exclude intracardiac thrombus (3.8%), and assess suspected myocardial perforation (1.8%).</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Among patients who underwent CCTA for CAD assessment (n=170), 58% were male and most had no prior atherosclerotic disease. Hypertension, dyslipidaemia and diabetes were present in 45%, 49% and 13% of patients, respectively. CCTA was most commonly performed for chest pain suggestive of non-cardiac origin (58%), with low levels of high-sensitivity cardiac troponin (12ng/dL, IQR 5-64). CCTA revealed no or non-obstructive CAD in 77% of patients, obstructive CAD in 15.3%, and was inconclusive in 6.5%. Following CCTA, 23.5% of patients required invasive coronary angiography and 11.8% underwent invasive treatment. The most frequent final ED diagnoses included non-specific chest pain (48.8%), acute coronary syndrome (11.2%), and peri/myocarditis (12.4%). During FU, 28.2% of patients reported recurrent chest pain, 2.4% of patients underwent invasive revascularization, and 0.6% had an acute coronary syndrome. At 1 year, one patient died (prosthetic aortic valve endocarditis).</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">CCT is a valuable tool for the differential diagnosis of chest pain in the ED, providing accurate and safe assessments without compromising patient prognosis. Its additional role in guiding pericardiocentesis and providing rapid anatomic characterization further supports its broad integration in ED workflows.</span></span></p>
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