Round-the-clock performance of coronary CT angiography for suspected acute coronary syndrome: Results from the BEACON trial

Abstract

Objective

To assess the image quality of coronary CT angiography (CCTA) for suspected acute coronary syndrome (ACS) outside office hours.

Methods

Patients with symptoms suggestive of an ACS underwent CCTA at the emergency department 24 hours, 7 days a week. A total of 118 patients, of whom 89 (75 %) presented during office hours (weekdays between 07:00 and 17:00) and 29 (25 %) outside office hours (weekdays between 17:00 and 07:00, weekends and holidays) underwent CCTA. Image quality was evaluated per coronary segment by two experienced readers and graded on an ordinal scale ranging from 1 to 3.

Results

There were no significant differences in acquisition parameters, beta-blocker administration or heart rate between patients presenting during office hours and outside office hours. The median quality score per patient was 30.5 [interquartile range 26.0–33.5] for patients presenting during office hours in comparison to 27.5 [19.75–32.0] for patients presenting outside office hours (p=0.043). The number of non-evaluable segments was lower for patients presenting during office hours (0 [0–1.0] vs. 1.0 [0–4.0], p=0.009).

Conclusion

Image quality of CCTA outside office hours in the diagnosis of suspected ACS is diminished.

Key Points

• Quality scores were higher for coronary-CTA during office hours.

• There were no differences in acquisition parameters.

• There was a non-significant trend towards higher heart rates outside office hours.

• Coronary-CTA on the ED requires state-of-the-art scanner technology and sufficiently trained staff.

• Coronary-CTA on the ED needs preparation time and optimisation of the procedure.