Document Type
Conference Proceeding
Publication Date
5-2024
Publication Title
Academic Emergency Medicine
Abstract
Background and Objectives: Patients presenting to the Emergency Department (ED) with chest pain who have an indeterminate (detectable to mildly elevated) troponin are often further evaluated with tests that use ionizing radiation. We hypothesized that patients initially evaluated with stress cardiac magnetic resonance (CMR) imaging receive less ionizing radiation through 1-year of follow-up than those initially evaluated with invasive angiography. Methods: We conducted a secondary analysis of the CMR-IMPACT trial, which randomized adult patients at 4 U.S. sites (9/2013– 7/2018) with a contemporary troponin of 0.006–1.0 ng/mL to either CMR imaging or invasive angiography. Cumulative radiation exposure from coronary computed tomography angiography, nuclear medicine stress imaging, cardiac catheterization, and percutaneous coronary intervention was assessed from index through 1-year using validated radiation dose estimates. Radiation doses at index and 1- year were compared between arms using linear regression adjusted for the stratification factors of initial troponin and known coronary artery disease in both intention to treat (ITT) and per protocol (PP) populations. Results: During the study period, 312 patients were enrolled, with 156 randomized to each arm (CMR vs. invasive angiography). In the ITT analysis, patients in the CMR arm had less radiation exposure at index compared to patients in the invasive angiography arm (4.7 ± 5.7 vs. 7.8 ± 5.8 mSv; p< 0.001). However, the difference in radiation exposure was not maintained at 1-year (7.5 ± 10.9 vs. 9.5 ± 8.4 mSv; p= 0.06). In the PP analysis, patients receiving CMR (N= 102) had less radiation exposure than those receiving invasive angiography (N= 104) at index (3.5 ± 5.1 vs. 9.3 ± 3.7 mSv; p< 0.001) and 1-year (5.8 ± 10.9 vs. 11.2 ± 8.1 mSv; p< 0.001). Conclusion: CMR was associated with decreased radiation exposure compared to invasive angiography. These findings suggest that a CMR-based risk stratification strategy may reduce iatrogenic radiation exposure.
Volume
31
Issue
S1
First Page
55
Recommended Citation
Lefebvre CW, Snavely AC, Ashburn NP, Franks N, Kiehl RR, Mahler SA, et al. [Clark CL]. Cardiac magnetic resonance imaging reduces radiation exposure in emergency department patients with chest pain. Acad Emerg Med. 2024 May;31(S1):55. doi:10.1111/acem.14533
DOI
10.1111/acem.14533
Comments
Society for Academic Emergency Medicine SAEM Annual Meeting, May 14-17, 2024, Phoenix, AZ