|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
|
|
|
|||||||||
|
|||||||||||
|
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 |
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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] )
| |||||||
Related Article
J. Am. Coll. Cardiol. 2007 49: 872-874.
This article has been cited by other articles:
|
|
 |
|
  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]
|
|
|
|
 |
|
 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]
|
|
|
|
 |
|
 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]
|
|
|
|
 |
|
 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]
|
|
|
|
 |
|
 H. Van Brabandt Recommendations or mere prose? Eur. Heart J., June 1, 2008; 29(11): 1473 - 1473. [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
|
|
 |
|
 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]
|
|
|
|
 |
|
 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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
|
|
 |
|
 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]
|
|
|
|
|
|
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]
|
|
|
|
 |
|
 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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
|
|
 |
|
 Multislice Coronary CT in Low-Risk Patients with Chest Pain Journal Watch Emergency Medicine, May 4, 2007; 2007(504): 4 - 4. [Full Text]
|
|
|
|
 |
|
 Multislice CT for Evaluation of Acute Chest Pain in the ED? Journal Watch (General), April 3, 2007; 2007(403): 5 - 5. [Full Text]
|
|
|
|
|
|
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]
|
|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
