Impact of Coronary Computed Tomography Angiography Findings on Initiation of Cardioprotective Medications

Coronary computed tomography angiography (CCTA) has been shown to be highly sensitive for coronary artery disease and acute coronary syndrome.1,2 Few studies have evaluated changes in medical management after CCTA.3,4 Prior studies suggest increases in medical management in the cardiology setting, but none has directly compared CCTA to standard emergency department (ED) care. We sought to determine the difference in initiation of aspirin or statins depending on whether patients were evaluated with CCTA or standard care for acute chest pain. This is a prespecified analysis of a randomized controlled multicenter trial comparing a CCTA-based strategy with traditional rule-out approaches for low- to intermediate-risk patients presenting to the ED with chest pain and possible acute coronary syndrome (ClinicalTrials.gov number: NCT00933400). The full study protocol has been published elsewhere.1 Briefly, patients ≥30 years of age with possible acute coronary syndrome were enrolled and randomized in EDs or observation units at 5 sites. This study was approved by the institutional review boards at participating sites, and all patients provided written informed consent. The degree of maximal stenosis was defined as the maximal stenosis reported from the CCTA scan and was categorized as follows: none, no stenosis; mild, 1% to 49%; moderate, 50% to …