JAMA : the journal of the American Medical Association
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Randomized Controlled Trial Multicenter Study Comparative Study
Computed tomographic pulmonary angiography vs ventilation-perfusion lung scanning in patients with suspected pulmonary embolism: a randomized controlled trial.
Ventilation-perfusion (V(dot)Q(dot) lung scanning and computed tomographic pulmonary angiography (CTPA) are widely used imaging procedures for the evaluation of patients with suspected pulmonary embolism. Ventilation-perfusion scanning has been largely replaced by CTPA in many centers despite limited comparative formal evaluations and concerns about CTPA's low sensitivity (ie, chance of missing clinically important pulmonary embuli). ⋯ In this study, CTPA was not inferior to V(dot)Q(dot scanning in ruling out pulmonary embolism. However, significantly more patients were diagnosed with pulmonary embolism using the CTPA approach. Further research is required to determine whether all pulmonary emboli detected by CTPA should be managed with anticoagulant therapy.
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Allowing the emergency department physician to activate the cardiac catheterization laboratory is a key strategy to reduce door-to-balloon times in patients with ST-segment elevation myocardial infarction (STEMI). There are limited data on the frequency of "false-positive" catheterization laboratory activation in patients undergoing percutaneous coronary intervention for suspected STEMI. ⋯ The frequency of false-positive cardiac catheterization laboratory activation for suspected STEMI is relatively common in community practice, depending on the definition of false-positive. Recent emphasis on rapid door-to-balloon times must also consider the consequences of false-positive catheterization laboratory activation.