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Coronary CTA Predictive, Resource-Saving When Used in Emergency Department

By Yael L. Maxwell

SAN FRANCISCO, CA—Using coronary computed tomographic angiography (CTA) to assess patients who present with chest pain in the emergency department (ED) is a cost-effective and accurate screening method for coronary artery disease, according to results presented March 10, 2013, at the American College of Cardiology Scientific Session/i2 Summit.

For ACRIN PA 4005, Judd E. Hollander, MD, of the University of Pennsylvania (Philadelphia, PA), and colleagues randomized 1,368 patients who presented with chest pain at 5 institutions to cardiac CTA in the ED (n = 907) or traditional screening tools (n = 461).

At 1 year, safety outcomes were low and similar in both cohorts (table 1).

Table 1. Overall Safety at 1 Year

 

 

Coronary CTA
(n = 907)

Traditional
(n = 461)

Difference (95% CI)

All-cause Mortality

0.2%

1%

-0.43% (-6.0% to 5.2%)

Cardiac Death

0.1%

0

0.1% (-5.5% to 5.7%)

AMI

1%

1%

0.1% (-5.6% to 5.9%)

Composite Death/AMI

1%

1%

0.3% (-5.5% to 6.0%)

Revascularization

3%

2%

1.3% (-4.4% to 7.0%)

 

Looking at only the 92.8% (n = 1,270) of patients who were not found to have CAD, coronary CTA was as accurate as traditional screening in predicting 1-year outcomes (table 2).

Table 2. Safety at 1 Year in Patients Without CAD

 

 

Coronary CTA
(n = 825)

Traditional
(n = 445)

Difference (95% CI)

All-cause Mortality

0.2%

0.7%

-0.43% (-6.2% to 5.3%)

Cardiac Death

0.1%

0

0.12% (-5.7% to 5.9%)

AMI

0.1%

0.2%

-0.11% (-6.0% to 5.8%)

Composite Death/AMI

0.2%

0.2%

0.02% (-5.9% to 5.9%)

Revascularization

0

0.5%

-0.47% (-6.3% to 5.4%)

Use of resources post-hospital discharge, including CAD diagnostic testing, echocardiogram, and medication, at 1 year was similar regardless of coronary CTA use.

“But resources are applied more appropriately since patients are more likely to have determination of underlying coronary disease,” Dr. Hollander said. When coronary CTA is used, “more disease is identified and treated and more patients without disease are not treated.”

However, “you have to individualize,” Dr. Hollander warned, adding that he views coronary CTA as an “exclusionary test. We want to avoid a scenario where everyone gets this whether they need it or not.”

Study Details

Patients averaged 50 years of age, slightly more than half of the cohort was female, and 14% had diabetes.

 

 

 

Source:Hollander J. One year outcomes and resource utilization in ACRIN PA 4005: Multicenter RCT of a rapid 'rule-out' strategy using coronary CT Angiography vs. traditional care for low-risk ED patients with potential acute coronary syndromes. Presented at: American College of Cardiology Scientific Session/i2 Summit; March 10, 2013; San Francisco, CA.

 

 

 

 

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Disclosures
  • Dr. Hollander reports receiving consulting fees/honoraria from CSL Behring and Radiometer, and research grants from Abbott, Alere, Brahms, Pennsylvania Department of Health, PCORI, and Siemens.

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