冠状动脉CTA与运动心电图对急性胸痛的诊断性能：急诊科倾向评分匹配研究

IF 2.9 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Journal of Radiology Open Pub Date : 2026-06-01 Epub Date: 2026-02-01 DOI:10.1016/j.ejro.2026.100734

Alessandro Marchetti , Eleonora Moliterno , Giuseppe Rovere , Lorenzo Giarletta , Alessio Perazzolo , Domenico Amatulli , Antonio De Vita , Massimo Muciaccia , Francesco Lauriero , Giancarlo Savino , Anna Rita Larici , Biagio Merlino , Marcello Covino , Gaetano Antonio Lanza , Giovanna Liuzzo , Francesco Franceschi , Francesco Burzotta , Luigi Natale , Riccardo Marano

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引用次数: 0

摘要

目的：比较运动心电图（ex-ECG）和冠状动脉CT血管造影（CCTA）在急诊科（ED）急性胸痛（ACP）和疑似非st段抬高急性冠状动脉综合征（NSTE-ACS）患者诊断-治疗护理途径中的临床效果和操作效率。方法：这项单中心回顾性队列研究在2022年1月至2023年12月期间招募了428名连续出现ACP的患者。在对年龄、性别、心脏评分和分诊代码进行倾向评分匹配（PSM）后，两组214名患者分别进行了心电图检查或CCTA检查。主要结局包括诊断试验阳性、住院率和急诊科住院时间。次要结果包括需要进行有创冠状动脉造影（ICA）和血运重建率。结果：前心电图组和CCTA组在检测阳性（42对31例，p = 0.157）和住院率（42对30例，p = 0.121）方面无统计学差异。ICA发生率相似（36例vs 32例，p = 0.597），血循环重建率相似（各13例，p = 1.000）。然而，与前心电图相比，接受CCTA的出院患者ED总停留时间明显缩短（1710 vs 1841 min, p ）。结论：前心电图和CCTA对ACP和疑似NSTE-ACS患者的临床影响和操作效率相当。CCTA提供了有效的优势，显著减少了急诊科的住院时间，使患者安全出院，在不影响诊断质量的情况下改善了资源管理。这些发现支持CCTA在急诊科ACP和疑似NSTE-ACS的诊断途径中越来越多地被采用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Diagnostic performance of coronary CTA versus exercise electrocardiography in acute chest pain: A propensity score-matched study in the emergency department

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Diagnostic performance of coronary CTA versus exercise electrocardiography in acute chest pain: A propensity score-matched study in the emergency department

Purpose

To compare the clinical impact and operational efficiency of exercise electrocardiography (ex-ECG) and coronary CT angiography (CCTA) in the diagnostic-therapeutic care pathway of patients presenting to the Emergency Department (ED) with acute chest pain (ACP) and suspected non-ST-elevation acute coronary syndrome (NSTE-ACS).

Methods

This single-center retrospective cohort study enrolled 428 consecutive patients presenting with ACP between January 2022 and December 2023. After propensity score matching (PSM) for age, sex, Heart Score, and triage code, two balanced groups of 214 patients each underwent either -ex-ECG or CCTA. Primary outcomes included diagnostic test positivity, hospital admission rate, and ED length-stay. Secondary outcomes included need for invasive coronary angiography (ICA) and revascularization rates.

Results

No statistically significant differences were found in test positivity (42 vs 31 patients, p = 0.157) or hospital admission rates (42 vs 30 patients, p = 0.121) between ex-ECG and CCTA groups. The ICA rates were similar (36 vs 32 patients, p = 0.597), as were revascularization rates (13 patients each, p = 1.000). However, discharged patients undergoing CCTA had significantly shorter total ED length-stay compared to ex-ECG (1710 vs 1841 min, p < 0.001), representing a 7.12 % reduction.

Conclusion

Both ex-ECG and CCTA demonstrate comparable clinical impact and operational efficiency in patients with ACP and suspected NSTE-ACS. CCTA offers effective advantages with significantly reduced ED length-stay for a safe discharge of the patients, improving resource management without compromising diagnostic quality. These findings support the increasing adoption of CCTA in the diagnostic pathway for ACP and suspected NSTE-ACS in the ED setting.

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