Intraaortic balloon support for myocardial infarction with cardiogenic shock

angiography reduces the overall length of stay in the hospital and also allowed for the direct discharge from the emergency room.At the same time, there was no decrease in the overall cost of care and increased radiation exposure.Now putting these results in proper perspective, the patients of ROMICAT II had an average age of 54 years, 47% were women, all had normal ECG's and all had normal troponin levels.With all these parameters, the probability of occurrence of coronary artery disease itself is so low that whether one needs to do further testing at all in these patients can be questioned and most definitely cannot be recommended as a general policy for all.Most of us would probably not ask for any investigations beyond a few hours of observation, some serial ECGs and a troponin level at the end of it all!If you want to consider this from country wise perspective then for a country like the USA where even one missed coronary event can lead to a lawsuit, protective medicine will probably result in this study leading to CTA becoming part of the emergency room protocols for chest pain.This type of protective medicine fortunately is not yet practiced in India.If we look at the cost of care of chest pain (excess of Rs 2 lakhs!), then perhaps a CTA within a few hours of admission cutting down the cost of admission could be one new way of looking at this issue but then this was not the question addressed in this study.At the same time one should not discount the utility of coronary CT angiography in select situations in the emergency room, where you want to be very confident about the coronary anatomy (e.g.VIP or faculty colleague or relative) or where a patient keeps coming back and will not be convinced without a normal report, then a CTA is the answer.So, in conclusion, in most situations especially as a public policy, simple observation and clinical testing would be better than CTA, though a CTA should always be available for selected situations.