Optimizing evaluation of patients with low-to-intermediate-risk acute chest pain: A randomized study comparing stress myocardial perfusion tomography incorporating stress-only imaging versus cardiac CT

Research output: Contribution to journalArticle

Faisal Nabi, Mahwash Kassi, Kamil Muhyieddeen, Su Min Chang, Jiaqiong Xu, Leif Peterson, Nelda Wray, Beverly Shirkey, Carol Ashton, John Mahmarian

The purpose of this study was to determine whether stress myocardial perfusion (SPECT) optimized with stress-only (SO) imaging is comparable to cardiac CT angiography (CTA) for evaluating patients with acute chest pain (ACP). Methods: This was a prospective randomized observational study in 598 ACP patients who underwent CTA versus SPECT. The primary endpoint was length of hospital stay, and secondary endpoints were test feasibility, time to diagnosis, diagnostic accuracy, radiation exposure, and overall cost. Median follow-up was 6.5 mo, with a 3.8% cardiac event rate defined as death or an acute coronary syndrome. Results: Of 2,994 patients screened, 1,703 (56.9%) were not candidates for CTA because of prior cardiac disease (41%) or imaging contraindications (16%). Time to diagnosis (8.1 ± 8.5 vs. 9.4 ± 7.4 h) and length of hospital stay (19.7 ± 27.8 vs. 23.5 ± 34.4 h) were significantly shorter with CTA than with SPECT (P = 0.002). However, time to diagnosis (7.0 ± 6.2 vs. 6.8 ± 5.9 h, P = 0.20), length of stay (15.5 ± 17.2 vs. 16.7 ± 15.3 h, P = 0.36), and hospital costs ($4,242 ± $3,871 vs. $4,364 ± 1781, P = 0.86) were comparable with CTA versus SO SPECT, respectively. SO was also superior to conventional SPECT regarding all of the above metrics and significantly reduced radiation exposure (5.5 ± 4.4 vs. 12.5 ± 2.7 mSv, P <0.0001). Conclusion: Stress SPECT when optimized with SO imaging is similar to CTA in time to diagnosis, length of hospital stay, and cost, with improved prognostic accuracy and less radiation exposure. Our results emphasize the importance of SO imaging, particularly in low-intermediate-risk emergency room patients who are a population likely to have a normal test result.

Original languageEnglish (US)
Pages (from-to)378-384
Number of pages7
JournalJournal of Nuclear Medicine
Volume57
Issue number3
DOIs
StatePublished - Mar 1 2016

PMID: 26635341

Altmetrics

Cite this

Standard

Optimizing evaluation of patients with low-to-intermediate-risk acute chest pain : A randomized study comparing stress myocardial perfusion tomography incorporating stress-only imaging versus cardiac CT. / Nabi, Faisal; Kassi, Mahwash; Muhyieddeen, Kamil; Chang, Su Min; Xu, Jiaqiong; Peterson, Leif; Wray, Nelda; Shirkey, Beverly; Ashton, Carol; Mahmarian, John.

In: Journal of Nuclear Medicine, Vol. 57, No. 3, 01.03.2016, p. 378-384.

Research output: Contribution to journalArticle

Harvard

Nabi, F, Kassi, M, Muhyieddeen, K, Chang, SM, Xu, J, Peterson, L, Wray, N, Shirkey, B, Ashton, C & Mahmarian, J 2016, 'Optimizing evaluation of patients with low-to-intermediate-risk acute chest pain: A randomized study comparing stress myocardial perfusion tomography incorporating stress-only imaging versus cardiac CT' Journal of Nuclear Medicine, vol. 57, no. 3, pp. 378-384. https://doi.org/10.2967/jnumed.115.166595

APA

Nabi, F., Kassi, M., Muhyieddeen, K., Chang, S. M., Xu, J., Peterson, L., ... Mahmarian, J. (2016). Optimizing evaluation of patients with low-to-intermediate-risk acute chest pain: A randomized study comparing stress myocardial perfusion tomography incorporating stress-only imaging versus cardiac CT. Journal of Nuclear Medicine, 57(3), 378-384. https://doi.org/10.2967/jnumed.115.166595

Vancouver

Nabi F, Kassi M, Muhyieddeen K, Chang SM, Xu J, Peterson L et al. Optimizing evaluation of patients with low-to-intermediate-risk acute chest pain: A randomized study comparing stress myocardial perfusion tomography incorporating stress-only imaging versus cardiac CT. Journal of Nuclear Medicine. 2016 Mar 1;57(3):378-384. https://doi.org/10.2967/jnumed.115.166595

Author

Nabi, Faisal ; Kassi, Mahwash ; Muhyieddeen, Kamil ; Chang, Su Min ; Xu, Jiaqiong ; Peterson, Leif ; Wray, Nelda ; Shirkey, Beverly ; Ashton, Carol ; Mahmarian, John. / Optimizing evaluation of patients with low-to-intermediate-risk acute chest pain : A randomized study comparing stress myocardial perfusion tomography incorporating stress-only imaging versus cardiac CT. In: Journal of Nuclear Medicine. 2016 ; Vol. 57, No. 3. pp. 378-384.

BibTeX

@article{38f8073e73fe4319ab0c6965b8ae3523,
title = "Optimizing evaluation of patients with low-to-intermediate-risk acute chest pain: A randomized study comparing stress myocardial perfusion tomography incorporating stress-only imaging versus cardiac CT",
abstract = "The purpose of this study was to determine whether stress myocardial perfusion (SPECT) optimized with stress-only (SO) imaging is comparable to cardiac CT angiography (CTA) for evaluating patients with acute chest pain (ACP). Methods: This was a prospective randomized observational study in 598 ACP patients who underwent CTA versus SPECT. The primary endpoint was length of hospital stay, and secondary endpoints were test feasibility, time to diagnosis, diagnostic accuracy, radiation exposure, and overall cost. Median follow-up was 6.5 mo, with a 3.8{\%} cardiac event rate defined as death or an acute coronary syndrome. Results: Of 2,994 patients screened, 1,703 (56.9{\%}) were not candidates for CTA because of prior cardiac disease (41{\%}) or imaging contraindications (16{\%}). Time to diagnosis (8.1 ± 8.5 vs. 9.4 ± 7.4 h) and length of hospital stay (19.7 ± 27.8 vs. 23.5 ± 34.4 h) were significantly shorter with CTA than with SPECT (P = 0.002). However, time to diagnosis (7.0 ± 6.2 vs. 6.8 ± 5.9 h, P = 0.20), length of stay (15.5 ± 17.2 vs. 16.7 ± 15.3 h, P = 0.36), and hospital costs ($4,242 ± $3,871 vs. $4,364 ± 1781, P = 0.86) were comparable with CTA versus SO SPECT, respectively. SO was also superior to conventional SPECT regarding all of the above metrics and significantly reduced radiation exposure (5.5 ± 4.4 vs. 12.5 ± 2.7 mSv, P <0.0001). Conclusion: Stress SPECT when optimized with SO imaging is similar to CTA in time to diagnosis, length of hospital stay, and cost, with improved prognostic accuracy and less radiation exposure. Our results emphasize the importance of SO imaging, particularly in low-intermediate-risk emergency room patients who are a population likely to have a normal test result.",
keywords = "Cardiac computed tomography, Coronary artery calcium, Single photon tomography",
author = "Faisal Nabi and Mahwash Kassi and Kamil Muhyieddeen and Chang, {Su Min} and Jiaqiong Xu and Leif Peterson and Nelda Wray and Beverly Shirkey and Carol Ashton and John Mahmarian",
year = "2016",
month = "3",
day = "1",
doi = "10.2967/jnumed.115.166595",
language = "English (US)",
volume = "57",
pages = "378--384",
journal = "Journal of Nuclear Medicine",
issn = "0161-5505",
publisher = "Society of Nuclear Medicine Inc.",
number = "3",

}

RIS

TY - JOUR

T1 - Optimizing evaluation of patients with low-to-intermediate-risk acute chest pain

T2 - Journal of Nuclear Medicine

AU - Nabi, Faisal

AU - Kassi, Mahwash

AU - Muhyieddeen, Kamil

AU - Chang, Su Min

AU - Xu, Jiaqiong

AU - Peterson, Leif

AU - Wray, Nelda

AU - Shirkey, Beverly

AU - Ashton, Carol

AU - Mahmarian, John

PY - 2016/3/1

Y1 - 2016/3/1

N2 - The purpose of this study was to determine whether stress myocardial perfusion (SPECT) optimized with stress-only (SO) imaging is comparable to cardiac CT angiography (CTA) for evaluating patients with acute chest pain (ACP). Methods: This was a prospective randomized observational study in 598 ACP patients who underwent CTA versus SPECT. The primary endpoint was length of hospital stay, and secondary endpoints were test feasibility, time to diagnosis, diagnostic accuracy, radiation exposure, and overall cost. Median follow-up was 6.5 mo, with a 3.8% cardiac event rate defined as death or an acute coronary syndrome. Results: Of 2,994 patients screened, 1,703 (56.9%) were not candidates for CTA because of prior cardiac disease (41%) or imaging contraindications (16%). Time to diagnosis (8.1 ± 8.5 vs. 9.4 ± 7.4 h) and length of hospital stay (19.7 ± 27.8 vs. 23.5 ± 34.4 h) were significantly shorter with CTA than with SPECT (P = 0.002). However, time to diagnosis (7.0 ± 6.2 vs. 6.8 ± 5.9 h, P = 0.20), length of stay (15.5 ± 17.2 vs. 16.7 ± 15.3 h, P = 0.36), and hospital costs ($4,242 ± $3,871 vs. $4,364 ± 1781, P = 0.86) were comparable with CTA versus SO SPECT, respectively. SO was also superior to conventional SPECT regarding all of the above metrics and significantly reduced radiation exposure (5.5 ± 4.4 vs. 12.5 ± 2.7 mSv, P <0.0001). Conclusion: Stress SPECT when optimized with SO imaging is similar to CTA in time to diagnosis, length of hospital stay, and cost, with improved prognostic accuracy and less radiation exposure. Our results emphasize the importance of SO imaging, particularly in low-intermediate-risk emergency room patients who are a population likely to have a normal test result.

AB - The purpose of this study was to determine whether stress myocardial perfusion (SPECT) optimized with stress-only (SO) imaging is comparable to cardiac CT angiography (CTA) for evaluating patients with acute chest pain (ACP). Methods: This was a prospective randomized observational study in 598 ACP patients who underwent CTA versus SPECT. The primary endpoint was length of hospital stay, and secondary endpoints were test feasibility, time to diagnosis, diagnostic accuracy, radiation exposure, and overall cost. Median follow-up was 6.5 mo, with a 3.8% cardiac event rate defined as death or an acute coronary syndrome. Results: Of 2,994 patients screened, 1,703 (56.9%) were not candidates for CTA because of prior cardiac disease (41%) or imaging contraindications (16%). Time to diagnosis (8.1 ± 8.5 vs. 9.4 ± 7.4 h) and length of hospital stay (19.7 ± 27.8 vs. 23.5 ± 34.4 h) were significantly shorter with CTA than with SPECT (P = 0.002). However, time to diagnosis (7.0 ± 6.2 vs. 6.8 ± 5.9 h, P = 0.20), length of stay (15.5 ± 17.2 vs. 16.7 ± 15.3 h, P = 0.36), and hospital costs ($4,242 ± $3,871 vs. $4,364 ± 1781, P = 0.86) were comparable with CTA versus SO SPECT, respectively. SO was also superior to conventional SPECT regarding all of the above metrics and significantly reduced radiation exposure (5.5 ± 4.4 vs. 12.5 ± 2.7 mSv, P <0.0001). Conclusion: Stress SPECT when optimized with SO imaging is similar to CTA in time to diagnosis, length of hospital stay, and cost, with improved prognostic accuracy and less radiation exposure. Our results emphasize the importance of SO imaging, particularly in low-intermediate-risk emergency room patients who are a population likely to have a normal test result.

KW - Cardiac computed tomography

KW - Coronary artery calcium

KW - Single photon tomography

UR - http://www.scopus.com/inward/record.url?scp=84960156481&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84960156481&partnerID=8YFLogxK

U2 - 10.2967/jnumed.115.166595

DO - 10.2967/jnumed.115.166595

M3 - Article

VL - 57

SP - 378

EP - 384

JO - Journal of Nuclear Medicine

JF - Journal of Nuclear Medicine

SN - 0161-5505

IS - 3

ER -

ID: 18932201