Busting cardiac CTA myths

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Lisa Fratt, Editor

There are a few fairly long-standing myths about cardiac CT angiography (CTA). The top two emphasize its exploding use and high costs. Yet, several studies published in this month's American Journal of Roentgenology attempted to put those myths to bed.

David C. Levin, MD, of the Center for Research on the Utilization of Imaging Services at Thomas Jefferson University Hospital and Jefferson Medical College in Philadelphia, and colleagues focused on the myth of exploding use. Indeed, after scouring years of Medicare Part B Physician/Supplier Procedure Summary Master Files of CTA and SPECT imaging, the authors revealed that CTA is underutilized.

In fact, the data surprised Levin, who found that CTA use actually dipped in 2008. Meanwhile, SPECT imaging was performed 44 times as often as CTA.

Alexander Goehler, MD, of the Institute for Technology Assessment at Massachusetts General Hospital in Boston, and colleagues took a different approach, constructing a simulation model of 1,000 low-to-intermediate risk chest pain patients who presented to the ED with chest pain.

The researchers assessed CTA, SPECT and stress echocardiography and demonstrated that CTA reduced initial and 30-day costs, cut the number of invasive catheterizations and improved survival.

These findings were echoed this week at the annual meeting of the American College of Cardiology (ACC) in New Orleans, where Michael Poon, MD, director of advanced cardiac imaging at The Heart Center at Stony Brook University Medical Center in Stony Brook, N.Y., shared compelling findings about cardiac CTA in the ED.

According to Poon, Stony Brook saved $1.5 million by employing 320-slice CT in the evaluation of patients who presented to the ED with acute chest pain. That’s because the center slashed its admit rate for these patients from nearly 50 percent to under 15 percent. Plus, the model cut the number of repeat offenders. That is, patients with a normal CTA are not returning to the ED time and time again.

What’s holding up the diffusion of CTA? It can take a decade or longer to change practice patterns. Plus, cardiologists are invested in SPECT imaging; there is a large inventory of in-office nuclear cameras. CTA reimbursement is less than favorable. And then, there is the tricky question of outcomes. Do patients really do better?

Poon and colleagues hope to answer the latter questions with additional papers in the future. Other comparative effectiveness studies tackling this issue include RESCUE, ACRIN PA 4005 and ROMICAT II.

It seems that the tide is turning as data demonstrating the clinical and economic value of CTA are accruing. As always, we welcome your insights.

Lisa Fratt
Editor of Health Imaging & IT