Our mission is to become a worldwide reference for education in the field for all professionals involved in the process to disseminate knowledge & skills of Acute Cardiovascular Care.
Our mission is to promote excellence in clinical diagnosis, research, technical development, and education in cardiovascular imaging in Europe.
Our mission is to promote excellence in research, practice, education and policy in cardiovascular health, primary and secondary prevention.
Our mission is to reduce the burden of cardiovascular disease in Europe through percutaneous cardiovascular interventions.
Our mission is to improve the quality of life of the population by reducing the impact of cardiac rhythm disturbances and reduce sudden cardiac death.
Our mission is to improve quality of life and longevity, through better prevention, diagnosis and treatment of heart failure, including the establishment of networks for its management, education and research.
The ESC Working Groups' goal is to stimulate and disseminate scientific knowledge in different fields of cardiology.
The ESC Councils' goal is to share knowledge among medical professionals practising in specific cardiology domains.
OUR MISSION: TO REDUCE THE BURDEN OF CARDIOVASCULAR DISEASE
The evaluation of patients with acute chest pain is a challenging
clinical task. Standard testing is often non-conclusive, and the
consequences of a missed diagnosis can be severe. Despite a low
threshold to hospital admission, of whom the vast majority turns out not
to have an acute coronary syndrome, still a small number of patients
are inappropriately discharged from the emergency ward. For these
reasons the care of acute chest pain patients are a logistic and
financial burden to the healthcare system. Immediate non-invasive
coronary angiography by cardiac CT holds promise as a means to
effectively exclude an acute disease. However, previous observational
studies, including the ROMICAT study [Hoffmann, J Am Coll Cardiol.
2009], have shown that the interpretation of the cardiac CT scan is not
straightforward under these circumstances. In addition, there is
virtually no prospective data on the logistic and economic performance
in comparison to alternative tests in the evaluation of acute chest
In a multicenter, clinical trial in 16 emergency departments nearly
700 low-risk patients were randomized between contrast-enhanced cardiac
CT (CCT) and stress/rest SPECT myocardial perfusion imaging (MPI) as the
index non-invasive test. CCT found no or minimal coronary artery
disease in 82% of patients (73% of total immediately discharged),
intermediate disease in 10%, and severe obstructive disease in 10%,
while only 4% was regarded non-interpretable. MPI was normal in 90%, and
80% could be discharged immediately. CT resulted in a 54% reduction in
time to diagnosis (from randomization till test result) compared with
MPI: 2.9h vs. 6.3h (p < 0.0001), which reduced the cost of care in
the emergency ward from US$3,458 to US$2,137, a 38% reduction. There
were very few major adverse events (myocardial infarction, unstable
angina, cardiac death and revascularizations) in both groups: 0.8% for
CCT vs. 0.4% for MPI (p = 0.29). Patients with low calcium scores or
less than 25% obstructive disease could be sent home safely. The authors
conclude that in low-risk acute chest pain CCTA results in an equally
safe, but more rapid and cost-efficient diagnosis than rest-stress MPI.
This study is groundbreaking as one of the first multicenter
randomized trial to examine the incremental value of cardiac CT in
patients with acute chest pain. Both CT and MPI were shown to be equally
safe, but with logistic advantages for CCT. Although there was a
non-significant trend towards fewer immediate discharges, more secondary
testing, CCT was less expensive, mostly because it could be performed
faster. As the authors conclude the results of the present study are
limited to low-risk patients with chest pain, without a previous history
of CAD and in the absence of contraindications to CT (recruitment rate
11%). The logistic and economic advantages may vary depending on the
local setting, did not include downstream management, and may be
smaller using contemporary SPECT equipment and protocols (without rest
acquisitions), as Michael Salerno and colleagues comment in an
accompanying editorial. Finally, what constitutes standard care in
low-risk acute chest pain varies around the globe. Whether CCT maintains
it’s logistic and economic advantage in comparison in different
settings has yet to be investigated. Although substantial tasks lie
ahead, the CT-STAT investigators are to be complemented for this
important step towards clinical validation of cardiac CT in the setting
of acute chest pain.
© 2017 European Society of Cardiology. All rights reserved