Coronary Computed Tomography Angiography Versus Traditional Care: Comparison of One-Year Outcomes and Resource Use - 23/03/16
, Constantine Gatsonis, PhD c, d, Erin M. Greco, MS c, Bradley S. Snyder, MS c, Anna Marie Chang, MD a, Chadwick D. Miller, MD, MS e, Harjit Singh, MD f, Harold I. Litt, MD, PhD b, †Abstract |
Study objective |
Three large, multicenter, randomized, clinical trials have shown that coronary computed tomography (CT) angiography allows efficient evaluation and safe discharge of patients with low- to intermediate-risk chest pain who present to the emergency department (ED). We report 1-year event rates and resource use from the American College of Radiology Imaging Network-Pennsylvania 4005 multicenter trial.
Methods |
Patients with low- to intermediate-risk chest pain and presenting to the ED were randomized in a 2:1 ratio to a coronary CT angiography care pathway or traditional care. Subjects were contacted by telephone at least 1 year after ED presentation. Medical record review was performed for all cardiac hospitalizations, procedures and diagnostic tests, and adverse cardiac events. Our main outcome was the composite of cardiac death and myocardial infarction within 1 year. The secondary outcome was resource use.
Results |
One thousand three hundred sixty-eight patients enrolled and 1,285 (94%) had direct participant or proxy contact at 1 year. All others had record review or death index search. From index presentation through 1 year, there was no difference between patients in the coronary CT angiography arm versus traditional care with respect to major adverse cardiac event (1.4% versus 1.1%; difference 0.3%; 95% CI –5.5% to 6.0%). From hospital discharge through 1 year, there was also no difference in ED revisits (36% versus 38%; difference –2.1%; 95% CI –7.9% to 3.7%), hospital admissions (16% versus 17%; difference –0.9%; 95% CI –6.7% to 4.9%), or subsequent cardiac testing (13% versus 13%; difference –0.4%; 95% CI –6.2% to 5.5%). One of 640 subjects with a negative coronary CT angiography result had a major adverse cardiac event within 1 year of presentation (0.16%; 95% CI 0.004% to 0.87%).
Conclusion |
A coronary CT angiography–based strategy for evaluation of patients with low- to intermediate-risk chest pain who present to the ED does not result in increased resource use during 1 year. A negative coronary CT angiography result is associated with a less than 1% major adverse cardiac event rate during the first year after testing.
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| Please see page 461 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Deborah B. Diercks, MD |
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| Author contributions: JEH, CG, BSS, and HIL designed the study. All authors performed data collection, interpretation of results, and study oversight at their respective sites. CG, EMG, and BSS were responsible for data analysis. JEH and HIL were responsible for preparing the article, and all authors critically reviewed it. JEH takes responsibility for the paper as a whole. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). The authors have stated that no such relationships exist and provided the following details: This project is funded, in part, under a grant with the Pennsylvania Department of Health. The Department specifically declaims responsibility for any analyses, interpretations or conclusions. Additional funding was provided by the ACR Fund for Imaging Innovation. |
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| Trial registration number: NCT00933400 |
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| A podcast for this article is available at www.annemergmed.com. |
Vol 67 - N° 4
P. 460 - aprile 2016 Ritorno al numero
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