TY - JOUR
T1 - Combined stress myocardial CT perfusion and coronary CT angiography as a feasible strategy among patients presenting with acute chest pain to the emergency department
AU - Grandhi, Gowtham R.
AU - Batlle, Juan C.
AU - Maroules, Christopher D.
AU - Janowitz, Warren
AU - Peña, Constantino S.
AU - Ziffer, Jack A.
AU - Macedo, Robson
AU - Nasir, Khurram
AU - Cury, Ricardo C.
N1 - Funding Information:
Funding: This work was supported by a Research grant from GE Healthcare , Chicago, ILClinical Trial number: NCT02538861.
Funding Information:
Dr. Ricardo C. Cury is a recipient of research grant from GE Healthcare , is a consultant at Covera Health and Cleerly. Dr Juan C. Batlle is a member of Boehringer Ingelheim Speakers Bureau.
Publisher Copyright:
© 2020 Society of Cardiovascular Computed Tomography
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/3/1
Y1 - 2021/3/1
N2 - Background: A combined approach of myocardial CT perfusion (CTP) with coronary CT angiography (CTA) was shown to have better diagnostic accuracy than coronary CTA alone. However, data on cost benefits and length of stay when compared to other perfusion imaging modalities has not been evaluated. Therefore, we aim to perform a feasibility study to assess direct costs and length of stay of a combined stress CTP/CTA and use SPECT myocardial perfusion imaging (SPECT-MPI) as a benchmark, among chest pain patients at intermediate-risk for acute coronary syndrome (ACS) presenting to the emergency department (ED). Methods: This is a prospective two-arm clinical trial (NCT02538861) with 43 patients enrolled in stress CTP/CTA arm (General Electric Revolution CT) and 102 in SPECT-MPI arm. Mean age of the study population was 65 ± 12 years; 56% were men. We used multivariable linear regression analysis to compare length of stay and direct costs between the two modalities. Results: Overall, 9 out of the 43 patients (21%) with CTP/CTA testing had an abnormal test. Of these 9 patients, 7 patients underwent invasive coronary angiography and 6 patients were found to have obstructive coronary artery disease. Normal CTP/CTA test was found in 34 patients (79%), who were discharged home and all patients were free of major adverse cardiac events at 30 days. The mean length of stay was significantly shorter by 28% (mean difference: 14.7 h; 95% CI: 0.7, 21) among stress CTP/CTA (20 h [IQR: 16, 37]) compared to SPECT-MPI (30 h [IQR: 19, 44.5]). Mean direct costs were significantly lower by 44% (mean difference: $1535; 95% CI: 987, 2082) among stress CTA/CTP ($1750 [IQR: 1474, 2114] compared to SPECT-MPI ($2837 [IQR: 2491, 3554]). Conclusion: Combined stress CTP/CTA is a feasible strategy for evaluation of chest pain patients presenting to ED at intermediate-risk for ACS and has the potential to lead to shorter length of stay and lower direct costs.
AB - Background: A combined approach of myocardial CT perfusion (CTP) with coronary CT angiography (CTA) was shown to have better diagnostic accuracy than coronary CTA alone. However, data on cost benefits and length of stay when compared to other perfusion imaging modalities has not been evaluated. Therefore, we aim to perform a feasibility study to assess direct costs and length of stay of a combined stress CTP/CTA and use SPECT myocardial perfusion imaging (SPECT-MPI) as a benchmark, among chest pain patients at intermediate-risk for acute coronary syndrome (ACS) presenting to the emergency department (ED). Methods: This is a prospective two-arm clinical trial (NCT02538861) with 43 patients enrolled in stress CTP/CTA arm (General Electric Revolution CT) and 102 in SPECT-MPI arm. Mean age of the study population was 65 ± 12 years; 56% were men. We used multivariable linear regression analysis to compare length of stay and direct costs between the two modalities. Results: Overall, 9 out of the 43 patients (21%) with CTP/CTA testing had an abnormal test. Of these 9 patients, 7 patients underwent invasive coronary angiography and 6 patients were found to have obstructive coronary artery disease. Normal CTP/CTA test was found in 34 patients (79%), who were discharged home and all patients were free of major adverse cardiac events at 30 days. The mean length of stay was significantly shorter by 28% (mean difference: 14.7 h; 95% CI: 0.7, 21) among stress CTP/CTA (20 h [IQR: 16, 37]) compared to SPECT-MPI (30 h [IQR: 19, 44.5]). Mean direct costs were significantly lower by 44% (mean difference: $1535; 95% CI: 987, 2082) among stress CTA/CTP ($1750 [IQR: 1474, 2114] compared to SPECT-MPI ($2837 [IQR: 2491, 3554]). Conclusion: Combined stress CTP/CTA is a feasible strategy for evaluation of chest pain patients presenting to ED at intermediate-risk for ACS and has the potential to lead to shorter length of stay and lower direct costs.
KW - Acute coronary syndrome
KW - Combined anatomical and functional assessment of coronaries
KW - Combined stress CTP/CTA
KW - Direct costs
KW - Length of stay
KW - Hospital Costs
KW - Predictive Value of Tests
KW - Prospective Studies
KW - Humans
KW - Middle Aged
KW - Myocardial Perfusion Imaging/economics
KW - Male
KW - Coronary Angiography/economics
KW - Cost Savings
KW - Feasibility Studies
KW - Time Factors
KW - Female
KW - Acute Coronary Syndrome/diagnostic imaging
KW - Computed Tomography Angiography/economics
KW - Length of Stay
KW - Risk Assessment
KW - Risk Factors
KW - Florida
KW - Angina Pectoris/diagnostic imaging
KW - Coronary Artery Disease/diagnostic imaging
KW - Tomography, Emission-Computed, Single-Photon/economics
KW - Cost-Benefit Analysis
KW - Aged
KW - Emergency Medical Services
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U2 - 10.1016/j.jcct.2020.06.195
DO - 10.1016/j.jcct.2020.06.195
M3 - Article
C2 - 32807703
AN - SCOPUS:85089375955
SN - 1934-5925
VL - 15
SP - 129
EP - 136
JO - Journal of cardiovascular computed tomography
JF - Journal of cardiovascular computed tomography
IS - 2
ER -