{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T06:33:57Z","timestamp":1780468437567,"version":"3.54.1"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2016,3,9]]},"abstract":"\n Background<\/jats:title>\n \n Cardiac computed tomography angiography (\n CCTA<\/jats:styled-content>\n ) reduces emergency department length of stay compared with standard evaluation in patients with low\u2010 and intermediate\u2010risk acute chest pain. Whether diabetic patients have similar benefits is unknown.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n In this prespecified analysis of the Rule Out Myocardial Ischemia\/Infarction by Computer Assisted Tomography (\n ROMICAT II)<\/jats:styled-content>\n multicenter trial, we randomized 1000 patients (17% diabetic) with symptoms suggestive of acute coronary syndrome to\n CCTA<\/jats:styled-content>\n or standard evaluation. The rate of acute coronary syndrome was 8% in both diabetic and nondiabetic patients (\n P<\/jats:italic>\n =1.0). Length of stay was unaffected by the\n CCTA<\/jats:styled-content>\n strategy for diabetic patients (23.9 versus 27.2\u00a0hours,\n P<\/jats:italic>\n =0.86) but was reduced for nondiabetic patients compared with standard evaluation (8.4 versus 26.5\u00a0hours,\n P<\/jats:italic>\n <0.0001;\n P<\/jats:italic>\n interaction=0.004).\n CCTA<\/jats:styled-content>\n resulted in 3\u2010fold more direct emergency department discharge in both groups (each\n P<\/jats:italic>\n \u22640.0001,\n P<\/jats:italic>\n interaction=0.27). No difference in hospital admissions was seen between the 2 strategies in diabetic and nondiabetic patients (\n P<\/jats:italic>\n interaction=0.09). Both groups had more downstream testing and higher radiation doses with\n CCTA<\/jats:styled-content>\n , but these were highest in diabetic patients (all\n P<\/jats:italic>\n interaction\u22640.04). Diabetic patients had fewer normal\n CCTAs<\/jats:styled-content>\n than nondiabetic patients (32% versus 50%,\n P<\/jats:italic>\n =0.003) and similar normalcy rates with standard evaluation (\n P<\/jats:italic>\n =0.70). Notably, 66% of diabetic patients had no or mild stenosis by\n CCTA<\/jats:styled-content>\n with short length of stay comparable to that of nondiabetic patients (\n P<\/jats:italic>\n =0.34), whereas those with >50% stenosis had a high prevalence of acute coronary syndrome, invasive coronary angiography, and revascularization.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Knowledge of coronary anatomy with\n CCTA<\/jats:styled-content>\n is beneficial for diabetic patients and can discriminate between lower risk patients with no or little coronary artery disease who can be discharged immediately and higher risk patients with moderate to severe disease who warrant further workup.\n <\/jats:p>\n <\/jats:sec>\n \n Clinical Trial Registration<\/jats:title>\n \n URL<\/jats:styled-content>\n :\n https:\/\/www.clinicaltrials.gov\/<\/jats:ext-link>\n . Unique identifier:\n NCT<\/jats:styled-content>\n 01084239.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.115.003137","type":"journal-article","created":{"date-parts":[[2018,9,14]],"date-time":"2018-09-14T12:32:07Z","timestamp":1536928327000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":16,"title":["Coronary CT Angiography Versus Standard Emergency Department Evaluation for Acute Chest Pain and Diabetic Patients: Is There Benefit With Early Coronary CT Angiography?"],"prefix":"10.1161","volume":"5","author":[{"given":"Quynh A.","family":"Truong","sequence":"first","affiliation":[{"name":"Dalio Institute of Cardiovascular Imaging, New York\u2010Presbyterian Hospital and Weill Cornell Medical College, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Schulman\u2010Marcus","sequence":"additional","affiliation":[{"name":"Dalio Institute of Cardiovascular Imaging, New York\u2010Presbyterian Hospital and Weill Cornell Medical College, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pearl","family":"Zakroysky","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital Biostatistics Center, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric T.","family":"Chou","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Fontana Medical Center, Fontana, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John T.","family":"Nagurney","sequence":"additional","affiliation":[{"name":"Emergency Department, Massachusetts General Hospital, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerome L.","family":"Fleg","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Schoenfeld","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital Biostatistics Center, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James E.","family":"Udelson","sequence":"additional","affiliation":[{"name":"Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Udo","family":"Hoffmann","sequence":"additional","affiliation":[{"name":"Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela K.","family":"Woodard","sequence":"additional","affiliation":[{"name":"Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000437738.63853.7a"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.29.02.06.dc05-1299"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(98)00327-1"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(92)90134-9"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2006.09.027"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2008.06.009"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1201161"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1201163"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.03.068"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.001736"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2012.01.028"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.191650"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.288.21.2693"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.nuclcard.2004.05.007"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc11-2403"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10554-012-0168-4"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1536\/ihj.53.23"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehp470"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcct.2015.03.001"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.115.003137","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T10:18:53Z","timestamp":1715595533000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.115.003137"}},"subtitle":["Results of the Randomized Comparative Effectiveness ROMICAT II Trial"],"short-title":[],"issued":{"date-parts":[[2016,3,9]]},"references-count":19,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2016,3,9]]}},"alternative-id":["10.1161\/JAHA.115.003137"],"URL":"https:\/\/doi.org\/10.1161\/jaha.115.003137","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,3,9]]},"assertion":[{"value":"2016-01-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-02-19","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-03-22","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e003137"}}