Coronary CT Angiography Versus Standard Emergency Department Evaluation for Acute Chest Pain and Diabetic Patients: Is There Benefit With Early Coronary CT Angiography?<subtitle>Results of the Randomized Comparative Effectiveness ROMICAT II Trial</subtitle>

Abstract

BackgroundCardiac computed tomography angiography (CCTA) reduces emergency department length of stay compared with standard evaluation in patients with low‐ and intermediate‐risk acute chest pain. Whether diabetic patients have similar benefits is unknown. Methods and ResultsIn this prespecified analysis of the Rule Out Myocardial Ischemia/Infarction by Computer Assisted Tomography (ROMICAT II) multicenter trial, we randomized 1000 patients (17% diabetic) with symptoms suggestive of acute coronary syndrome to CCTA or standard evaluation. The rate of acute coronary syndrome was 8% in both diabetic and nondiabetic patients (P=1.0). Length of stay was unaffected by the CCTA strategy for diabetic patients (23.9 versus 27.2 hours, P=0.86) but was reduced for nondiabetic patients compared with standard evaluation (8.4 versus 26.5 hours, P50% stenosis had a high prevalence of acute coronary syndrome, invasive coronary angiography, and revascularization. ConclusionsKnowledge of coronary anatomy with CCTA is beneficial for diabetic patients and can discriminate between lower risk patients with no or little coronary artery disease who can be discharged immediately and higher risk patients with moderate to severe disease who warrant further workup. Clinical Trial RegistrationURL: https://www.clinicaltrials.gov/. Unique identifier: NCT01084239.

Keywords

• acute coronary syndrome
• cardiac computed tomography
• chest pain diagnosis
• diabetes mellitus
• emergency department