000 03457nam a22004577a 4500
942 _cART
008 200902s20202020 xxu||||| |||| 00| 0 eng d
040 _aOvid MEDLINE(R)
099 _a32807703
245 _aCombined stress myocardial CT perfusion and coronary CT angiography as a feasible strategy among patients presenting with acute chest pain to the emergency department.
251 _aJournal of cardiovascular computed tomography. 2020 Jul 29
252 _aJ Cardiovasc Comput Tomogr. 2020 Jul 29
190 _aGrandhi GR
190 _aBatlle JC
190 _aMaroules CD
190 _aJanowitz W
190 _aPena CS
190 _aZiffer JA
190 _aMacedo R
190 _aNasir K
190 _aCury RC
100 _aGrandhi, Gowtham R
656 _aMedicine
651 _aMedStar Union Memorial Hospital
253 _aJournal of cardiovascular computed tomography
520 _aBACKGROUND: A combined approach of myocardial CT perfusion (CTP) with coronary CT angiography (CTA) was shown to have better diagnostic accuracy than coronary CTA alone. However, data on cost benefits and length of stay when compared to other perfusion imaging modalities has not been evaluated. Therefore, we aim to perform a feasibility study to assess direct costs and length of stay of a combined stress CTP/CTA and use SPECT myocardial perfusion imaging (SPECT-MPI) as a benchmark, among chest pain patients at intermediate-risk for acute coronary syndrome (ACS) presenting to the emergency department (ED).
520 _aMETHODS: This is a prospective two-arm clinical trial (NCT02538861) with 43 patients enrolled in stress CTP/CTA arm (General Electric Revolution CT) and 102 in SPECT-MPI arm. Mean age of the study population was 65 +/- 12 years; 56% were men. We used multivariable linear regression analysis to compare length of stay and direct costs between the two modalities.
520 _aRESULTS: Overall, 9 out of the 43 patients (21%) with CTP/CTA testing had an abnormal test. Of these 9 patients, 7 patients underwent invasive coronary angiography and 6 patients were found to have obstructive coronary artery disease. Normal CTP/CTA test was found in 34 patients (79%), who were discharged home and all patients were free of major adverse cardiac events at 30 days. The mean length of stay was significantly shorter by 28% (mean difference: 14.7 h; 95% CI: 0.7, 21) among stress CTP/CTA (20 h [IQR: 16, 37]) compared to SPECT-MPI (30 h [IQR: 19, 44.5]). Mean direct costs were significantly lower by 44% (mean difference:
_1535; 95% CI: 987, 2082) among stress CTA/CTP (
_1750 [IQR: 1474, 2114] compared to SPECT-MPI (
_2837 [IQR: 2491, 3554]).
520 _aCONCLUSION: Combined stress CTP/CTA is a feasible strategy for evaluation of chest pain patients presenting to ED at intermediate-risk for ACS and has the potential to lead to shorter length of stay and lower direct costs. Copyright (c) 2020 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
022 _a1876-861X
857 _uhttps://dx.doi.org/10.1016/j.jcct.2020.06.195
856 _uhttps://dx.doi.org/10.1016/j.jcct.2020.06.195
657 _aJournal Article
024 _aS1934-5925(20)30368-3 [pii]
024 _a10.1016/j.jcct.2020.06.195 [doi]
260 _saheadofprint
546 _aEnglish
260 _c2020
269 _fFY2021
999 _c8866