Advertisement

Submit Manuscripts
Author Information
Subscribe/Renew
Order Reprints
Email Alerts
Feedback
RSS Feed
CME

About the Journal
Editorial Board & Staff

About JACC CME
Hardware/Software Requirements
Contact Us
Policy on Privacy and Confidentiality
Copyright Information

JACC Imaging Homepage JACC Interventions Homepage
Still not a subscriber to JACC Imaging or JACC Interventions?
Click here
to sign up now!

ACC.org
Cardiosmart
Cardiosource
CVN
Imaging Library
JACC Imaging
JACC Interventions

Click here for more guidelines.
2009 Focused Updates: ACC/AHA Guidelines for STEMI and ACC/AHA/SCAI Guidelines for PCI
2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery
ACC 2009 Advocacy Position Statement: Principles for Comparative Effectiveness Research
CME Topic Collections Past Issues Search Current Issue Home
     

J Am Coll Cardiol, 2007; 49:863-871, doi:10.1016/j.jacc.2006.08.064 (Published online 9 February 2007).
© 2007 by the American College of Cardiology Foundation
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
j.jacc.2006.08.064v1
49/8/863    most recent
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Goldstein, J. A.
Right arrow Articles by Raff, G. L.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Goldstein, J. A.
Right arrow Articles by Raff, G. L.
Related Collections
Right arrowRelated Article

CLINICAL RESEARCH: CARDIAC IMAGING

A Randomized Controlled Trial of Multi-Slice Coronary Computed Tomography for Evaluation of Acute Chest Pain

James A. Goldstein, MD, FACC, Michael J. Gallagher, MD, William W. O’Neill, MD, FACC, Michael A. Ross, MD, FACEP, Brian J. O’Neil, MD, FACEP and Gilbert L. Raff, MD, FACC*

William Beaumont Hospital, Royal Oak, Michigan.

Manuscript received June 2, 2006; revised manuscript received August 11, 2006, accepted August 28, 2006.

* Reprint requests and correspondence: Dr. Gilbert L. Raff, William Beaumont Hospital, 3601 West 13 Mile Road, Royal Oak, Michigan 48073. (Email: graff{at}beaumont.edu).

OBJECTIVES: This study sought to compare the safety, diagnostic efficacy, and efficiency of multi-slice computed tomography (MSCT) with standard diagnostic evaluation of low-risk acute chest pain patients.

BACKGROUND: Over 1 million patients have emergency center evaluations for acute chest pain annually, at an estimated diagnostic cost of over $10 billion. Multi-slice computed tomography has a high negative predictive value for exclusion of coronary artery stenoses.

METHODS: We randomized patients to MSCT (n = 99) versus SOC (n = 98) protocols. The MSCT patients with minimal disease were discharged; those with stenosis >70% underwent catheterization, whereas cases with intermediate lesions or non-diagnostic scans underwent stress testing. Outcomes included: safety (freedom from major adverse events over 6 months), diagnostic efficacy (clinically correct and definitive diagnosis), as well as time and cost of care.

RESULTS: Both approaches were completely (100%) safe. The MSCT alone immediately excluded or identified coronary disease as the source of chest pain in 75% of patients, including 67 with normal coronary arteries and 8 with severe disease referred for invasive evaluation. The remaining 25% of patients required stress testing, owing to intermediate severity lesions or non-diagnostic scans. During the index visit, MSCT evaluation reduced diagnostic time compared with SOC (3.4 h vs. 15.0 h, p < 0.001) and lowered costs ($1,586 vs. $1,872, p < 0.001). Importantly, MSCT patients required fewer repeat evaluations for recurrent chest pain (MSCT, 2 of 99 (2.0%) patients vs. SOC, 7 of 99 (7%) patients; p = 0.10).

CONCLUSIONS: Multi-slice computed tomographic coronary angiography can definitively establish or exclude coronary disease as the cause of chest pain. However, inability to determine the physiological significance of intermediate severity coronary lesions and cases with inadequate image quality are present limitations. (Study of Coronary Artery Computed Tomography to Diagnose Emergency Chest Pain CR; http://clinicaltrials.gov/ct/show/NCT00273832?order=1; NCT00273832 [ClinicalTrials.gov] )

Abbreviations and Acronyms
  ECG = electrocardiogram
  ED = emergency department
  MACE = major adverse cardiac event
  MSCT = multi-slice computed tomography
  SOC = standard of care


Related Article

Spiral Computed Tomography Coronary Angiography: A New Diagnostic Tool Developing Its Role in Clinical Cardiology
Pim J. de Feyter and Niels van Pelt
J. Am. Coll. Cardiol. 2007 49: 872-874. [Full Text] [PDF]



This article has been cited by other articles:


Home page
 RadiologyHome page
G. Bastarrika, Y. S. Lee, W. Huda, B. Ruzsics, P. Costello, and U. J. Schoepf
CT of Coronary Artery Disease
Radiology, November 1, 2009; 253(2): 317 - 338.
[Abstract] [Full Text] [PDF]

Home page
 Health Aff (Millwood)Home page
J. A. Ladapo, J. R. Horwitz, M. C. Weinstein, G. S. Gazelle, and D. M. Cutler
Adoption And Spread Of New Imaging Technology: A Case Study
Health Aff., November 1, 2009; 28(6): w1122 - w1132.
[Abstract] [Full Text] [PDF]

Home page
 JNMHome page
L. J. Shaw and J. Narula
Risk Assessment and Predictive Value of Coronary Artery Disease Testing
J. Nucl. Med., August 1, 2009; 50(8): 1296 - 1306.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Roentgenol.Home page
G. Bastarrika, C. Thilo, G. F. Headden, P. L. Zwerner, P. Costello, and U. J. Schoepf
Cardiac CT in the Assessment of Acute Chest Pain in the Emergency Department
Am. J. Roentgenol., August 1, 2009; 193(2): 397 - 409.
[Abstract] [Full Text] [PDF]

Home page
 RadiologyHome page
E. J. Halpern
Triple-Rule-Out CT Angiography for Evaluation of Acute Chest Pain and Possible Acute Coronary Syndrome
Radiology, August 1, 2009; 252(2): 332 - 345.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Roentgenol.Home page
J. M. May, W. P. Shuman, J. N. Strote, K. R. Branch, L. M. Mitsumori, D. W. Lockhart, and J. H. Caldwell
Low-Risk Patients With Chest Pain in the Emergency Department: Negative 64-MDCT Coronary Angiography May Reduce Length of Stay and Hospital Charges
Am. J. Roentgenol., July 1, 2009; 193(1): 150 - 154.
[Abstract] [Full Text] [PDF]

Home page
 JAMAHome page
G. L. Raff, K. M. Chinnaiyan, D. A. Share, T. Y. Goraya, E. A. Kazerooni, M. Moscucci, R. E. Gentry, A. Abidov, and for the Advanced Cardiovascular Imaging Consortium
Radiation Dose From Cardiac Computed Tomography Before and After Implementation of Radiation Dose-Reduction Techniques
JAMA, June 10, 2009; 301(22): 2340 - 2348.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll Cardiol ImgHome page
A. Sarwar, L. J. Shaw, M. D. Shapiro, R. Blankstein, U. Hoffman, R. C. Cury, S. Abbara, T. J. Brady, M. J. Budoff, R. S. Blumenthal, et al.
Diagnostic and Prognostic Value of Absence of Coronary Artery Calcification
J. Am. Coll. Cardiol. Img., June 1, 2009; 2(6): 675 - 688.
[Abstract] [Full Text] [PDF]

Home page
 NEJMHome page
A. C. McCulloch, S. Paulin, S. K. Gerard, G. Karthikeyan, G. Vorobiof, W. M. Fogarty Jr., J. A.C. Lima, J. M. Miller, the CORE 64 Investigators, J. Walsh, et al.
Coronary Angiography by 64-Row CT
N. Engl. J. Med., May 7, 2009; 360(19): 2027 - 2031.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
U. Hoffmann, F. Bamberg, C. U. Chae, J. H. Nichols, I. S. Rogers, S. K. Seneviratne, Q. A. Truong, R. C. Cury, S. Abbara, M. D. Shapiro, et al.
Coronary computed tomography angiography for early triage of patients with acute chest pain: the ROMICAT (Rule Out Myocardial Infarction using Computer Assisted Tomography) trial.
J. Am. Coll. Cardiol., May 5, 2009; 53(18): 1642 - 1650.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
M. A. Hlatky
Evaluating use of coronary computed tomography angiography in the emergency department.
J. Am. Coll. Cardiol., May 5, 2009; 53(18): 1651 - 1652.
[Full Text] [PDF]

Home page
 Circ Cardiovasc ImagingHome page
U. Hoffmann and F. Bamberg
Is Computed Tomography Coronary Angiography the Most Accurate and Effective Noninvasive Imaging Tool to Evaluate Patients With Acute Chest Pain in the Emergency Department?: CT Coronary Angiography Is the Most Accurate and Effective Noninvasive Imaging Tool for Evaluating Patients Presenting With Chest Pain to the Emergency Department
Circ Cardiovasc Imaging, May 1, 2009; 2(3): 251 - 263.
[Full Text] [PDF]

Home page
 Circ Cardiovasc ImagingHome page
R. C. Hendel
Is Computed Tomography Coronary Angiography the Most Accurate and Effective Noninvasive Imaging Tool to Evaluate Patients With Acute Chest Pain in the Emergency Department?: CT Coronary Angiography Is the Most Accurate and Effective Noninvasive Imaging Tool for Evaluating Patients Presenting With Chest Pain to the Emergency Department: Antagonist Viewpoint
Circ Cardiovasc Imaging, May 1, 2009; 2(3): 264 - 275.
[Full Text] [PDF]

Home page
 Am. J. Roentgenol.Home page
K. M. Takakuwa, E. J. Halpern, E. L. Gingold, D. C. Levin, and F. S. Shofer
Radiation Dose in a "Triple Rule-Out" Coronary CT Angiography Protocol of Emergency Department Patients Using 64-MDCT: The Impact of ECG-Based Tube Current Modulation on Age, Sex, and Body Mass Index
Am. J. Roentgenol., April 1, 2009; 192(4): 866 - 872.
[Abstract] [Full Text] [PDF]

Home page
 Mayo Clin Proc.Home page
J. Sanchis, V. Bodi, J. Nunez, L. Mainar, E. Nunez, P. Merlos, E. Rumiz, G. Minana, X. Bosch, and A. Llacer
Efficacy of Coronary Revascularization in Patients With Acute Chest Pain Managed in a Chest Pain Unit
Mayo Clin. Proc., April 1, 2009; 84(4): 323 - 329.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
S. Ramcharitar, F. Pugliese, C. Schultz, J. Ligthart, P. de Feyter, H. Li, N. Mollet, M. van de Ent, P. W. Serruys, and R. J. van Geuns
Integration of multislice computed tomography with magnetic navigation facilitates percutaneous coronary interventions without additional contrast agents.
J. Am. Coll. Cardiol., March 3, 2009; 53(9): 741 - 746.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll Cardiol ImgHome page
J. A. Goldstein
Coronary plaque characterization by computed tomographic angiography: present promise and future hope.
J. Am. Coll. Cardiol. Img., February 1, 2009; 2(2): 161 - 163.
[Full Text] [PDF]

Home page
 ESC Textbook of Cardiovascular MedicineHome page
P. J. de Feyter, S. Achenbach, and K. Nieman
CHAPTER 6 Cardiovascular Computed Tomography
ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter.
[Abstract] [Full Text] [PDF]

Home page
 Clin. Chem.Home page
A. S. Jaffe
Key Issues in the Developing Synergism between Cardiovascular Imaging and Biomarkers
Clin. Chem., September 1, 2008; 54(9): 1432 - 1442.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
R. C. Cury, K. Shash, J. T. Nagurney, G. Rosito, M. D. Shapiro, C. H. Nomura, S. Abbara, F. Bamberg, M. Ferencik, E. J. Schmidt, et al.
Cardiac Magnetic Resonance With T2-Weighted Imaging Improves Detection of Patients With Acute Coronary Syndrome in the Emergency Department
Circulation, August 19, 2008; 118(8): 837 - 844.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Roentgenol.Home page
J. A. Ladapo, U. Hoffmann, F. Bamberg, J. T. Nagurney, D. M. Cutler, M. C. Weinstein, and G. S. Gazelle
Cost-Effectiveness of Coronary MDCT in the Triage of Patients with Acute Chest Pain
Am. J. Roentgenol., August 1, 2008; 191(2): 455 - 463.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
M. M. Henneman, J. D. Schuijf, G. Pundziute, J. M. van Werkhoven, E. E. van der Wall, J. W. Jukema, and J. J. Bax
Noninvasive evaluation with multislice computed tomography in suspected acute coronary syndrome plaque morphology on multislice computed tomography versus coronary calcium score.
J. Am. Coll. Cardiol., July 15, 2008; 52(3): 216 - 222.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll Cardiol ImgHome page
S. Achenbach
Quantification of coronary artery stenoses by computed tomography.
J. Am. Coll. Cardiol. Img., July 1, 2008; 1(4): 472 - 474.
[Full Text] [PDF]

Home page
 HeartHome page
W T Roberts, J J Bax, and L C Davies
Cardiac CT and CT coronary angiography: technology and application
Heart, June 1, 2008; 94(6): 781 - 792.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
H. Van Brabandt
Recommendations or mere prose?
Eur. Heart J., June 1, 2008; 29(11): 1473 - 1473.
[Full Text] [PDF]

Home page
 Eur Heart JHome page
S. Schroeder, S. Achenbach, F. Bengel, C. Burgstahler, F. Cademartiri, P. J. de Feyter, R. George, P. Kaufmann, A. F. Kopp, J. Knuuti, et al.
Recommendations or mere prose?: reply
Eur. Heart J., June 1, 2008; 29(11): 1473 - 1474.
[Full Text] [PDF]

Home page
 Eur Heart JHome page
V. Stangl, V. Witzel, G. Baumann, and K. Stangl
Current diagnostic concepts to detect coronary artery disease in women
Eur. Heart J., March 2, 2008; 29(6): 707 - 717.
[Abstract] [Full Text] [PDF]

Home page
 JNMHome page
M. R. Vesely and V. Dilsizian
Nuclear Cardiac Stress Testing in the Era of Molecular Medicine
J. Nucl. Med., March 1, 2008; 49(3): 399 - 413.
[Abstract] [Full Text] [PDF]

Home page
 J. Nucl. Med. Technol.Home page
S. Prat-Gonzalez, J. Sanz, and M. J. Garcia
Cardiac CT: Indications and Limitations
J. Nucl. Med. Technol., March 1, 2008; 36(1): 18 - 24.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
S. Schroeder, S. Achenbach, F. Bengel, C. Burgstahler, F. Cademartiri, P. de Feyter, R. George, P. Kaufmann, A. F. Kopp, J. Knuuti, et al.
Cardiac computed tomography: indications, applications, limitations, and training requirements: Report of a Writing Group deployed by the Working Group Nuclear Cardiology and Cardiac CT of the European Society of Cardiology and the European Council of Nuclear Cardiology
Eur. Heart J., February 2, 2008; 29(4): 531 - 556.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
A. N. DeMaria, J. J. Bax, O. Ben-Yehuda, P. Clopton, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, J. D. Knoke, W. Y.W. Lew, J. A.C. Lima, et al.
Highlights of the year in JACC 2007.
J. Am. Coll. Cardiol., January 29, 2008; 51(4): 490 - 512.
[Full Text] [PDF]

Home page
 J Am Coll Cardiol ImgHome page
T. M. Bateman
Business aspects of cardiovascular computed tomography: tackling the challenges.
J. Am. Coll. Cardiol. Img., January 1, 2008; 1(1): 111 - 118.
[Abstract] [Full Text] [PDF]

Home page
 RadiologyHome page
C. S. White and D. Kuo
Chest Pain in the Emergency Department: Role of Multidetector CT
Radiology, December 1, 2007; 245(3): 672 - 681.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
S. K Seneviratne, F. Bamberg, and U. Hoffmann
CT angiography: front line for acute coronary syndromes now?
Heart, November 1, 2007; 93(11): 1325 - 1326.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
R. Rubinshtein, D. A. Halon, R. Jaffe, B. Karkabi, M. Y. Flugelman, B. S. Lewis, T. Gaspar, N. Peled, A. Kogan, and R. Shapira
Response to Letter Regarding Article, "Usefulness of 64-Slice Cardiac Computed Tomographic Angiography for Diagnosing Acute Coronary Syndromes and Predicting Clinical Outcome in Emergency Department Patients With Chest Pain of Uncertain Origin"
Circulation, September 18, 2007; 116(12): e355 - e355.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
R. J. Gibbons, P. A. Araoz, and E. E. Williamson
The Year in Cardiac Imaging
J. Am. Coll. Cardiol., September 4, 2007; 50(10): 988 - 1003.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
F. Alfonso
Immediate Coronary Imaging for Acute Chest Pain: Are We There Yet?
J. Am. Coll. Cardiol., August 14, 2007; 50(7): 650 - 651.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
G. L. Raff and J. A. Goldstein
Coronary Angiography by Computed Tomography: Coronary Imaging Evolves
J. Am. Coll. Cardiol., May 8, 2007; 49(18): 1830 - 1833.
[Abstract] [Full Text] [PDF]

Home page
 JWatch Emergency Med.Home page
Multislice Coronary CT in Low-Risk Patients with Chest Pain
Journal Watch Emergency Medicine, May 4, 2007; 2007(504): 4 - 4.
[Full Text]

Home page
 JWatch GeneralHome page
Multislice CT for Evaluation of Acute Chest Pain in the ED?
Journal Watch (General), April 3, 2007; 2007(403): 5 - 5.
[Full Text]

Home page
 J Am Coll CardiolHome page
P. J. de Feyter and N. van Pelt
Spiral Computed Tomography Coronary Angiography: A New Diagnostic Tool Developing Its Role in Clinical Cardiology
J. Am. Coll. Cardiol., February 27, 2007; 49(8): 872 - 874.
[Full Text] [PDF]


 
  CME Topic Collections Past Issues Search Current Issue Home

Advertisement