OBJECTIVES: The aim of the study was to systematically review and perform a meta-analysis of randomized, controlled trials of coronary computed tomography angiography (CCTA) versus usual care (UC) triage of acute chest pain in the emergency department (ED). BACKGROUND: CCTA allows rapid evaluation of patients presenting to the ED with acute chest pain syndromes; however, the impact of such testing on patient management and downstream testing has emerged as a concern. METHODS: We systematically searched for randomized, controlled trials of CCTA in the ED and performed a meta-analysis of clinical outcomes. RESULTS: Four randomized, controlled trials were included, with 1,869 patients undergoing CCTA and 1,397 undergoing UC. There were no deaths and no difference in the incidence of myocardial infarction, post-discharge ED visits, or rehospitalizations. Four studies reported decreased length of stay with CCTA and 3 reported cost savings; 8.4% of patients undergoing CCTA versus 6.3% of those receiving UC underwent invasive coronary angiography (ICA), whereas 4.6% of patients undergoing CCTA versus 2.6% of those receiving UC underwent coronary revascularization. The odds ratio of ICA for CCTA patients versus UC patients was 1.36 (95% confidence interval [CI]: 1.03 to 1.80, p = 0.030), and for revascularization, it was 1.81 (95% CI: 1.20 to 2.72, p = 0.004). The absolute increase in ICA after CCTA was 21 per 1,000 CCTA patients (95% CI: 1.8 to 44.9), and the number needed to scan was 48. The absolute increase in revascularization after CCTA was 20 per 1,000 patients (95% CI: 5.0 to 41.4); the number needed to scan was 50. Both percutaneous coronary intervention and coronary artery bypass graft surgery independently contributed to the significant increase in revascularization. CONCLUSIONS: Compared with UC, the use of CCTA in the ED is associated with decreased ED cost and length of stay but increased ICA and revascularization.
OBJECTIVES: The aim of the study was to systematically review and perform a meta-analysis of randomized, controlled trials of coronary computed tomography angiography (CCTA) versus usual care (UC) triage of acute chest pain in the emergency department (ED). BACKGROUND:CCTA allows rapid evaluation of patients presenting to the ED with acute chest pain syndromes; however, the impact of such testing on patient management and downstream testing has emerged as a concern. METHODS: We systematically searched for randomized, controlled trials of CCTA in the ED and performed a meta-analysis of clinical outcomes. RESULTS: Four randomized, controlled trials were included, with 1,869 patients undergoing CCTA and 1,397 undergoing UC. There were no deaths and no difference in the incidence of myocardial infarction, post-discharge ED visits, or rehospitalizations. Four studies reported decreased length of stay with CCTA and 3 reported cost savings; 8.4% of patients undergoing CCTA versus 6.3% of those receiving UC underwent invasive coronary angiography (ICA), whereas 4.6% of patients undergoing CCTA versus 2.6% of those receiving UC underwent coronary revascularization. The odds ratio of ICA for CCTApatients versus UC patients was 1.36 (95% confidence interval [CI]: 1.03 to 1.80, p = 0.030), and for revascularization, it was 1.81 (95% CI: 1.20 to 2.72, p = 0.004). The absolute increase in ICA after CCTA was 21 per 1,000 CCTApatients (95% CI: 1.8 to 44.9), and the number needed to scan was 48. The absolute increase in revascularization after CCTA was 20 per 1,000 patients (95% CI: 5.0 to 41.4); the number needed to scan was 50. Both percutaneous coronary intervention and coronary artery bypass graft surgery independently contributed to the significant increase in revascularization. CONCLUSIONS: Compared with UC, the use of CCTA in the ED is associated with decreased ED cost and length of stay but increased ICA and revascularization.
Authors: Edward Hulten; Alexander Goehler; Marcio Sommer Bittencourt; Fabian Bamberg; Christopher L Schlett; Quynh A Truong; John Nichols; Khurram Nasir; Ian S Rogers; Scott G Gazelle; John T Nagurney; Udo Hoffmann; Ron Blankstein Journal: Circ Cardiovasc Qual Outcomes Date: 2013-09-10
Authors: Philipp Burghard; Fabian Plank; Christoph Beyer; Silvana Müller; Jakob Dörler; Marc-Michael Zaruba; Leo Pölzl; Gerhard Pölzl; Andrea Klauser; Stefan Rauch; Fabian Barbieri; Christian-Ekkehardt Langer; Wilfried Schgoer; Eric E Williamson; Gudrun Feuchtner Journal: Eur Radiol Date: 2018-06-04 Impact factor: 5.315
Authors: Simon A Mahler; Chadwick D Miller; Harold I Litt; Constantine A Gatsonis; Bradley S Snyder; Judd E Hollander Journal: Acad Emerg Med Date: 2015-03-24 Impact factor: 3.451
Authors: Maros Ferencik; Ting Liu; Thomas Mayrhofer; Stefan B Puchner; Michael T Lu; Pal Maurovich-Horvat; J Hector Pope; Quynh A Truong; James E Udelson; W Frank Peacock; Charles S White; Pamela K Woodard; Jerome L Fleg; John T Nagurney; James L Januzzi; Udo Hoffmann Journal: JACC Cardiovasc Imaging Date: 2015-10-14
Authors: M A Berny-Lang; C E Darling; A L Frelinger; M R Barnard; C S Smith; A D Michelson Journal: Int J Lab Hematol Date: 2014-05-08 Impact factor: 2.877
Authors: S Divakaran; M K Cheezum; E A Hulten; M S Bittencourt; M G Silverman; K Nasir; R Blankstein Journal: Br J Radiol Date: 2014-12-12 Impact factor: 3.039