Emergency CCTA: As good as traditional testing and no more demanding of resources

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 - ChestPain

Three major trials have already established the 30-day clinical and economic soundness of ordering coronary CT angiography (CCTA) in evaluations of patients who show up in the emergency department complaining of chest pain. A new study shows the CCTA pathway to be similarly strong at the 12-month mark.

In the multicenter study, led by Judd Hollander, MD, of Thomas Jefferson University in Philadelphia, only one of 640 CCTA patients, 0.16 percent, had a cardiac death and none had a myocardial infarction within a year of the original ED visit.

This did not significantly differ from patients who underwent traditional testing, in which the patient’s physician selected which tests to perform, if any.

Nor did the CCTA patients require greater resource use within the year.

According to the study report, published online Oct. 23 in  Annals of Emergency Medicine, 1,285 patients in the ED with low- to intermediate-risk chest pain were randomized in a 2:1 ratio to a CCTA care pathway or traditional care.

Subjects were subsequently contacted by telephone at least one year after the ED event, and the researchers reviewed their medical records.

With respect to major adverse cardiac event, there was no significant difference between patients in the CCTA arm versus traditional care (1.4 percent versus 1.1 percent).

From hospital discharge through one year, there was also no difference in:

  • ED revisits (36 percent versus 38 percent);
  • Hospital admissions (16 percent versus 17 percent); or
  • Subsequent cardiac testing (13 percent versus 13 percent).

In their study discussion, the authors point out the criticality of integrating test results with clinical judgment.

“The mere finding of coronary disease on coronary CT angiography does not mean that the coronary disease is the cause of the symptoms that led to the test,” they write. “Similarly, appearing to have reversible ischemia on a stress test does mean the patient actually has ischemic heart disease. Many of these tests can be falsely positive.”

Along with the efficiency gains shown in previous large and randomized trials, they add, “our results provide further motivation for implementation of coronary CT angiography–based strategies for evaluation” of ED patients with low- to intermediate-risk chest pain.