CT Angiography Accurate, Less Expensive Than Treadmill in Diagnosing ER Chest Pain

Washington, DC—Providing higher sensitivity and positive predictive value, coronary computed tomographic angiography (CTA) also provides rapid discharge at less expense than exercise treadmill testing, and should be considered the first-line diagnostic methodology for assessing low-intermediate chest pain in the emergency room, according to results of the randomized CT-COMPARE trial presented March 29, 2014, during the American College of Cardiology/i2 Scientific Session.

For the trial, Kelley R. Branch, MD, of the University of Washington School of Medicine (Seattle, WA), and colleagues randomized 562 subjects with low-intermediate chest pain after the first negative serum troponin at a large academic Australian hospital ER to dual source CTA (n = 322) or treadmill testing (n = 240). There were 214 negative studies and 27 positive studies in the treadmill testing arm, yielding 22 false-positive studies and 1 false-negative study. The CTA arm had 287 negative studies (95% with under 50% stenosis and 93 with no disease) and 35 positive studies. CTA also showed comparable diagnostic accuracy, with higher sensitivity and positive predictive value (table 1).

Table 1. Accuracy of Treadmill Testing and CTA





Positive Predictive Value

Negative Predictive Value


Treadmill Testing






CTA > 50%






CTA >70%






Length of stay was reduced with CTA (13.5 hrs; 95% CI 11.2-15.7) compared with treadmill testing (19.7 hrs; 95% CI 17.4-22.1; P < 0.0005). Per-patient cost utility (total hospital cost including downstream and labor costs) also was reduced by CTA by about 19%  ($2,193 vs $2,704; P < 0.001).

“CTA provides rapid discharge at less expense than [treadmill testing],” Dr. Branch said. “This suggests [CTA] should be considered first line in low-intermediate ER chest pain.”

Allan S. Jaffe, MD, of the Mayo Clinic (Rochester, MN) asked if there was any attempt to look at pre-test risk stratification to potentially spare patients from hospitalization. Dr. Branch responded that such data are being analyzed for a future paper on early risk stratification. In addition, “very high sensitivity troponin may be a good way to further stratify these patients in terms of further testing or not, and I understand these studies are ongoing,” he said.



Branch, KR. Diagnostic accuracy of CT angiography versus stress ECG: a large randomized prospective study of suspected acute coronary syndrome chest pain in the emergency department-“CTCOMPARE.” Presented at the American College of Cardiology/i2 Scientific Session. March 29, 2014. Washington, DC.


  • Dr. Branch reports no relevant conflicts of interest.

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