LAUSR

Background: Computed tomography coronary angiography (CTCA) is increasingly being used to exclude significant coronary artery disease (CAD) in acute chest pain syndrome (ACPS) to identify patients safe for early discharge We reviewed clinical outcomes of ACPS patients discharged after CTCA Method: All patients who underwent CTCA for ACPS between December 2015 and August 2016 at Middlemore Hospital were stratified into non-significant (absent or mild CAD) and significant CAD and outcomes reviewed (median of 4-years) Composite major adverse cardiovascular events (MACE) were cardiovascular mortality, acute coronary syndrome (ACS) or unplanned revascularisation ACPS readmission and statin adherence were also evaluated Result: A total of 122 patients were included for analysis (61% female, mean age 54±11 years) CTCA showed non-significant CAD in 86 patients (70%) and significant CAD in 36 patients (30%) At index CTCA, 34% in non-significant and 31% in significant CAD groups were troponin positive ACPS readmission rates in the non-significant and significant CAD groups were 19% and 53% respectively There was one MACE in the non-significant CAD group (1 cardiac death due to intraoperative mitral valve replacement complication) and eight MACE (22%) in the significant CAD group (1 cardiac death, 4 ACS, and 3 unplanned revascularisation) Additionally, 2 patients with non-significant CAD at index CTCA underwent invasive coronary angiography with no significant CAD identified Only 59% of patients with mild CAD were discharged on a statin, with a 4-year adherence of 78% Conclusion: CTCA-guided risk stratification of ACPS is a safe discharge strategy in patients with non-significant CAD Statin preventative therapy can be improved