CT angiography (CTA) rapidly and definitely excludes coronary artery disease as the cause of acute chest pain in less time, and at a lower cost, than stress imaging, according to a study presented at the 2006 American College of Cardiology (ACC) meeting in Atlanta.
"Immediate coronary CTA can safely triage low-risk acute chest pain patients with negative ECG and enzymes," said lead author Dr. Gilbert Raff, director of cardiovascular MRI and CT research at William Beaumont Hospital in Royal Oak, MI.
Raff's group prospectively randomized 200 patients with acute chest pain, deemed low on the Goldman/Reilly criteria scale, to either immediate 64-slice CTA or a standard of care evaluation including serial cardiac enzymes, ECGs, and sestamibi rest-stress nuclear scanning.
According to the results, the length of stay in the emergency department (considered the primary outcome in this study) was reduced by 43.4% with CTA to 12.5 hours versus 22.1 hours with standard care.
Of the patients who had CTA, 67% were immediately discharged from the emergency department due to negative findings, while 8% went on to receive catheterization. Based on the CTA results, 75% had immediate disposition while 25% required crossover to SPECT testing. Of this 25%, 11% had unreadable scans in at least one segment.
The cost of care was decreased by 15.3% using CTA compared to standard care, even when including the cost of sending patients back for SPECT.
However, there were some differences between CTA and other testing modalities. Immediate catheterization occurred in 10% of the CTA group versus 2% in the standard evaluation, Raff said. The 90-day cumulative outcome for positive catheterization findings was 9.1% for the CTA group and 1.0% for the standard care group.
By Crystal Phend
AuntMinnie.com contributing writer
April 11, 2006
Related Reading
CTA finds heart disease when calcium score is unreliable, April 5, 2006
ST elevation during dobutamine stress echo warrants angiography, April 4, 2006
64-slice CTA reliably detects stenoses by patient, less so by vessel and segment, March 23, 2006
CT doesn't hurt when evaluating emergency chest pain, August 15, 2005
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