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Cardiac MRI Reduces Adverse Events for Patients with Acute Chest Pain

By MedImaging International staff writers
Posted on 09 Jul 2013

Clinicians have found that using stress cardiac magnetic resonance (CMR) imaging in an emergency department (ED) observation unit to care for patients with acute chest pain is a valuable tool for both the patient and the institution.

In a small, single-center clinical trial, Chadwick Miller, MD, MS, and colleagues from Wake Forest Baptist Medical Center (Winston-Salem, NC, USA) revealed that evaluating older, more complex patients in the observation unit with stress cardiac MRI, as opposed to usual inpatient care, reduced hospital readmissions, coronary revascularization procedures, and the need for additional cardiac testing.

The observation unit is a part of the emergency department designed for short stays—longer than a typical ED visit, according to Dr. Miller, but shorter than a hospital admission. “We were looking at the optimum way to evaluate people with chest pain and focusing on those patients who are generally older, have many risk factors for coronary disease, or may have had prior health problems, basically the intermediate to higher risk population,” Dr. Miller said. “At most hospitals in the United States, after evaluation in the emergency department, these patients are admitted to the hospital to complete their care.”

The study was published online in June 2013 ahead of print in the journal JACC: Cardiovascular Imaging. Dr. Miller, who serves as director of clinical research and executive vice-chair of Emergency Medicine at Wake Forest Baptist, noted that the study built on earlier studies that more complex patients managed in an observation unit with stress CMR testing experienced a reduction in care costs of about USD 2,100 per patient per year. The researchers, for this research, wanted to specifically look at three care events: coronary revascularization, hospital readmissions, and additional heart testing.

The researchers recruited 105 patients from Wake Forest Baptist’s ED, randomizing them to receive care either in the observation unit with CMR or in the hospital. The patients were followed for 90 days, after which the researchers found significant reductions in coronary revascularization procedures, fewer hospital readmissions, and fewer recurrent cardiac testing episodes or the need for additional testing.

“What's exciting about this is not only can we reduce events that are important to patients, but we can reduce costs as well,” Dr. Miller said. “What we think is happening is that the cardiac MRI is more accurately selecting patients who will benefit the most from having invasive procedures done. It’s a win-win.”

However, the single-center design of the study is a drawback, noted Dr. Miller, and these findings need to be validated across multiple centers to confirm the findings.

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63 (290.87066650391): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=212 ORDER BY `ordering`

64 (61.988830566406): select jos_twitters.link from jos_twitters where cat=10

65 (30.994415283203): select jos_facebook.link from jos_facebook where cat=10

66 (30.994415283203): select jos_google_plus.link from jos_google_plus where cat=10

67 (28.848648071289): select jos_linkedin.link from jos_linkedin where cat=10

68 (32.901763916016): SELECT fid FROM jos_deeppockets WHERE id=294747150 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294747150 AND published='1' LIMIT 1

69 (37.908554077148): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=212 ORDER BY `ordering`

70 (344.99168395996): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294747150 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (255.10787963867): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294747150 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (39.100646972656): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (51.975250244141): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (66.041946411133): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (46.014785766602): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294747150 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (30.040740966797): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294747150 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (33.140182495117): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (105.14259338379): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (61.03515625): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (51.975250244141): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (182.8670501709): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747150 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747150 AND published='1' LIMIT 1

105 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747150 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747150 AND published='1' LIMIT 1

106 (60.081481933594): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294747150 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (50.067901611328): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294747150 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (114.91775512695): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747150 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747150 AND published='1' LIMIT 1

109 (59.843063354492): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747150 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747150 AND published='1' LIMIT 1

110 (79.870223999023): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294747150 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (662.08839416504): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294747150 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (612.97416687012): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (399.11270141602): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (90.122222900391): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747150 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747150 AND published='1' LIMIT 1

115 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747150 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747150 AND published='1' LIMIT 1

116 (92.983245849609): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747150 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747150 AND published='1' LIMIT 1

117 (43.869018554688): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747150 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747150 AND published='1' LIMIT 1

118 (113.96408081055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747150 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747150 AND published='1' LIMIT 1

119 (42.915344238281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747150 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747150 AND published='1' LIMIT 1

120 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747150 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747150 AND published='1' LIMIT 1

121 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747150 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747150 AND published='1' LIMIT 1

122 (370.02563476562): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 22495.985031128): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

124 (581.97975158691): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294747150 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294747150 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 8718.9674377441): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (97.036361694336): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (54.121017456055): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (41.961669921875): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (87.976455688477): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (47.922134399414): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (422.00088500977): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (52.928924560547): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (34.809112548828): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (28.133392333984): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (917.19627380371): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747150 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (672.1019744873): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747150 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (735.99815368652): SELECT name FROM jos_deeppockets WHERE id=212

138 (45.061111450195): SELECT name FROM jos_deeppockets WHERE id=212

139 (!!!!! 1701.1165618896): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (658.98895263672): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (194.07272338867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747150 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747150 AND published='1' LIMIT 1

142 (111.10305786133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747150 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747150 AND published='1' LIMIT 1

143 (!!!!! 4400.9685516357): TRUNCATE TABLE jos_trademed_module

144 (123.97766113281): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294747150 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (89.883804321289): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294747150 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (401.97372436523): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747150 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (100.13580322266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747150 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747150 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747150 AND published='1' LIMIT 1

149 (43.869018554688): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747150 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747150 AND published='1' LIMIT 1

150 (!!!!! 1310.1100921631): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

151 (58.889389038086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747150 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747150 AND published='1' LIMIT 1

152 (43.153762817383): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747150 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747150 AND published='1' LIMIT 1

153 (32.901763916016): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294747150 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294747150 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (29.802322387695): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

155 (26.941299438477): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

156 (30.994415283203): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747150 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747150 AND published='1' LIMIT 1

158 (40.054321289062): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747150 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747150 AND published='1' LIMIT 1

159 (45.061111450195): select jos_twitters.link from jos_twitters where cat=10

160 (28.133392333984): select jos_facebook.link from jos_facebook where cat=10

161 (27.179718017578): select jos_google_plus.link from jos_google_plus where cat=10

162 (25.98762512207): select jos_linkedin.link from jos_linkedin where cat=10

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