BACKGROUND: The role of coronary computed tomography angiography (CCTA) in the management of symptomatic patients suspected of having coronary artery disease is expanding. However, prospective intermediate-term outcomes are lacking. OBJECTIVE: To compare CCTA with conventional noninvasive testing. DESIGN: Randomized, controlled comparative effectiveness trial. (ClinicalTrials.gov: NCT00705458). SETTING:Telemetry-monitored wards of an inner-city medical center. PATIENTS: 400 patients with acute chest pain (mean age, 57 years); 63% women; 54% Hispanic and 37% African-American; and low socioeconomic status. INTERVENTION: CCTA or radionuclide stress myocardial perfusion imaging (MPI). MEASUREMENTS: The primary outcome was cardiac catheterization not leading to revascularization within 1 year. Secondary outcomes included length of stay, resource utilization, and patient experience. Safety outcomes included death, major cardiovascular events, and radiation exposure. RESULTS: Thirty (15%) patients who had CCTA and 32 (16%) who had MPI underwent cardiac catheterization within 1 year. Fifteen (7.5%) and 20 (10%) of these patients, respectively, did not undergo revascularization (difference, -2.5 percentage points [95% CI, -8.6 to 3.5 percentage points]; hazard ratio, 0.77 [CI, 0.40 to 1.49]; P = 0.44). Median length of stay was 28.9 hours for the CCTA group and 30.4 hours for the MPI group (P = 0.057). Median follow-up was 40.4 months. For the CCTA and MPI groups, the incidence of death (0.5% versus 3%; P = 0.12), nonfatal cardiovascular events (4.5% versus 4.5%), rehospitalization (43% versus 49%), emergency department visit (63% versus 58%), and outpatient cardiology visit (23% versus 21%) did not differ. Long-term, all-cause radiation exposure was lower for the CCTA group (24 versus 29 mSv; P < 0.001). More patients in the CCTA group graded their experience favorably (P = 0.001) and would undergo the examination again (P = 0.003). LIMITATION: This was a single-site study, and the primary outcome depended on clinical management decisions. CONCLUSION: The CCTA and MPI groups did not significantly differ in outcomes or resource utilization over 40 months. Compared with MPI, CCTA was associated with less radiation exposure and with a more positive patient experience. PRIMARY FUNDING SOURCE: American Heart Association.
RCT Entities:
BACKGROUND: The role of coronary computed tomography angiography (CCTA) in the management of symptomatic patients suspected of having coronary artery disease is expanding. However, prospective intermediate-term outcomes are lacking. OBJECTIVE: To compare CCTA with conventional noninvasive testing. DESIGN: Randomized, controlled comparative effectiveness trial. (ClinicalTrials.gov: NCT00705458). SETTING: Telemetry-monitored wards of an inner-city medical center. PATIENTS: 400 patients with acute chest pain (mean age, 57 years); 63% women; 54% Hispanic and 37% African-American; and low socioeconomic status. INTERVENTION: CCTA or radionuclidestress myocardial perfusion imaging (MPI). MEASUREMENTS: The primary outcome was cardiac catheterization not leading to revascularization within 1 year. Secondary outcomes included length of stay, resource utilization, and patient experience. Safety outcomes included death, major cardiovascular events, and radiation exposure. RESULTS: Thirty (15%) patients who had CCTA and 32 (16%) who had MPI underwent cardiac catheterization within 1 year. Fifteen (7.5%) and 20 (10%) of these patients, respectively, did not undergo revascularization (difference, -2.5 percentage points [95% CI, -8.6 to 3.5 percentage points]; hazard ratio, 0.77 [CI, 0.40 to 1.49]; P = 0.44). Median length of stay was 28.9 hours for the CCTA group and 30.4 hours for the MPI group (P = 0.057). Median follow-up was 40.4 months. For the CCTA and MPI groups, the incidence of death (0.5% versus 3%; P = 0.12), nonfatal cardiovascular events (4.5% versus 4.5%), rehospitalization (43% versus 49%), emergency department visit (63% versus 58%), and outpatient cardiology visit (23% versus 21%) did not differ. Long-term, all-cause radiation exposure was lower for the CCTA group (24 versus 29 mSv; P < 0.001). More patients in the CCTA group graded their experience favorably (P = 0.001) and would undergo the examination again (P = 0.003). LIMITATION: This was a single-site study, and the primary outcome depended on clinical management decisions. CONCLUSION: The CCTA and MPI groups did not significantly differ in outcomes or resource utilization over 40 months. Compared with MPI, CCTA was associated with less radiation exposure and with a more positive patient experience. PRIMARY FUNDING SOURCE: American Heart Association.
Authors: James A Goldstein; Kavitha M Chinnaiyan; Aiden Abidov; Stephan Achenbach; Daniel S Berman; Sean W Hayes; Udo Hoffmann; John R Lesser; Issam A Mikati; Brian J O'Neil; Leslee J Shaw; Michael Y H Shen; Uma S Valeti; Gilbert L Raff Journal: J Am Coll Cardiol Date: 2011-09-27 Impact factor: 24.094
Authors: James K Min; Allison Dunning; Fay Y Lin; Stephan Achenbach; Mouaz Al-Mallah; Matthew J Budoff; Filippo Cademartiri; Tracy Q Callister; Hyuk-Jae Chang; Victor Cheng; Kavitha Chinnaiyan; Benjamin J W Chow; Augustin Delago; Martin Hadamitzky; Joerg Hausleiter; Philipp Kaufmann; Erica Maffei; Gilbert Raff; Leslee J Shaw; Todd Villines; Daniel S Berman Journal: J Am Coll Cardiol Date: 2011-08-16 Impact factor: 24.094
Authors: Venkatesh L Murthy; Masanao Naya; Courtney R Foster; Jon Hainer; Mariya Gaber; Gilda Di Carli; Ron Blankstein; Sharmila Dorbala; Arkadiusz Sitek; Michael J Pencina; Marcelo F Di Carli Journal: Circulation Date: 2011-10-17 Impact factor: 29.690
Authors: W Lane Duvall; John A Savino; Elliot J Levine; Usman Baber; Jonathan T Lin; Andrew J Einstein; Luke K Hermann; Milena J Henzlova Journal: J Nucl Cardiol Date: 2013-12-06 Impact factor: 5.952
Authors: Brian A Mc Ardle; Taylor F Dowsley; Robert A deKemp; George A Wells; Rob S Beanlands Journal: J Am Coll Cardiol Date: 2012-10-03 Impact factor: 24.094
Authors: Edward Hulten; Todd C Villines; Michael K Cheezum; Daniel S Berman; Allison Dunning; Stephan Achenbach; Mouaz Al-Mallah; Matthew J Budoff; Filippo Cademartiri; Tracy Q Callister; Hyuk-Jae Chang; Victor Y Cheng; Kavitha Chinnaiyan; Benjamin J W Chow; Ricardo C Cury; Augustin Delago; Gudrun Feuchtner; Martin Hadamitzky; Jörg Hausleiter; Philipp A Kaufmann; Ronald P Karlsberg; Yong-Jin Kim; Jonathon Leipsic; Fay Y Lin; Erica Maffei; Fabian Plank; Gilbert L Raff; Troy M Labounty; Leslee J Shaw; James K Min Journal: Am J Cardiol Date: 2012-12-01 Impact factor: 2.778
Authors: Leslee J Shaw; Jörg Hausleiter; Stephan Achenbach; Mouaz Al-Mallah; Daniel S Berman; Matthew J Budoff; Fillippo Cademartiri; Tracy Q Callister; Hyuk-Jae Chang; Yong-Jin Kim; Victor Y Cheng; Benjamin J W Chow; Ricardo C Cury; Augustin J Delago; Allison L Dunning; Gudrun M Feuchtner; Martin Hadamitzky; Ronald P Karlsberg; Philipp A Kaufmann; Jonathon Leipsic; Fay Y Lin; Kavitha M Chinnaiyan; Erica Maffei; Gilbert L Raff; Todd C Villines; Troy Labounty; Millie J Gomez; James K Min Journal: J Am Coll Cardiol Date: 2012-10-17 Impact factor: 24.094
Authors: Michael C Honigberg; Bradley S Lander; Vinit Baliyan; Maeve Jones-O'Connor; Emma W Healy; Jan-Erik Scholtz; John T Nagurney; Udo Hoffmann; Brian B Ghoshhajra; Pradeep Natarajan Journal: JACC Cardiovasc Imaging Date: 2019-07-17
Authors: Gianluca Pontone; Alexia Rossi; Marco Guglielmo; Marc R Dweck; Oliver Gaemperli; Koen Nieman; Francesca Pugliese; Pal Maurovich-Horvat; Alessia Gimelli; Bernard Cosyns; Stephan Achenbach Journal: Eur Heart J Cardiovasc Imaging Date: 2022-02-22 Impact factor: 6.875
Authors: Andrew J Foy; Sanket S Dhruva; Brandon Peterson; John M Mandrola; Daniel J Morgan; Rita F Redberg Journal: JAMA Intern Med Date: 2017-11-01 Impact factor: 21.873
Authors: George Cm Siontis; Dimitris Mavridis; John P Greenwood; Bernadette Coles; Adriani Nikolakopoulou; Peter Jüni; Georgia Salanti; Stephan Windecker Journal: BMJ Date: 2018-02-21