Acute Coronary Syndrome Clinical Trial
Official title:
Randomized Cost Comparison of Cardiac MRI Use in ED Patients With Chest Pain
The purpose of this study is to investigate the best way to evaluate patients with chest pain in the emergency department. It compares receiving treatment in an observation unit with admission to the hospital. Patients treated in the observation unit will undergo cardiac Magnetic Resonance Imaging (MRI) testing. Patients treated with hospital admission will undergo the testing their doctor determines is best for them. All patients will undergo follow up to find out if they have had any heart related events.
Almost half of patients presenting to the Emergency Department (ED) with possible cardiac
chest pain are at intermediate risk for short term death or infarction. Most are admitted to
the hospital for serial ECG's, cardiac biomarkers, cardiology consultation, and stress
testing or coronary angiogram. However, the 2007 ACC/AHA guidelines suggest that these
patients can be managed in an observation unit (OU). Recently, cardiac magnetic resonance
imaging (CMR) has proven more accurate than traditional testing modalities for the diagnosis
of acute coronary syndrome (ACS), and has also received endorsement from the American College
of Cardiology (ACC)/American Heart Association (AHA) guidelines. Immediate application of CMR
in an OU may improve health care utilization compared to standard hospital admission for
intermediate risk patients.
Research hypotheses:
1. Patients in an OU CMR protocol will have lower cost for the index hospitalization than
standard care.
2. An OU CMR protocol for patients with intermediate risk chest pain will significantly
improve the frequency of correct cardiovascular admission decisions when compared to
standard care.
Methods summary:
110 ED patients at intermediate risk for short-term death or infarction, with nondiagnostic
Electrocardiograms (ECG) and normal initial cardiac biomarkers, will be randomized to
standard care or OU CMR protocols. Subjects in the OU CMR protocol will undergo CMR perfusion
and stress testing, followed by serial biomarkers. Standard care subjects will be admitted
for usual cardiac testing. ACS (infarction, death, coronary revascularization, unstable
angina) will be assessed by evaluation of hospital course and phone follow-up at 30 days.
Cost of hospital care will be compared among groups.
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