The CT-STAT (Coronary Computed Tomographic Angiography for Systematic Triage of Acute Chest Pain Patients to Treatment) trial.
نویسندگان
چکیده
OBJECTIVES The purpose of this study was to compare the efficiency, cost, and safety of a diagnostic strategy employing early coronary computed tomographic angiography (CCTA) to a strategy employing rest-stress myocardial perfusion imaging (MPI) in the evaluation of acute low-risk chest pain. BACKGROUND In the United States, >8 million patients require emergency department evaluation for acute chest pain annually at an estimated diagnostic cost of >$10 billion. METHODS This multicenter, randomized clinical trial in 16 emergency departments ran between June 2007 and November 2008. Patients were randomly allocated to CCTA (n = 361) or MPI (n = 338) as the index noninvasive test. The primary outcome was time to diagnosis; the secondary outcomes were emergency department costs of care and safety, defined as freedom from major adverse cardiac events in patients with normal index tests, including 6-month follow-up. RESULTS The CCTA resulted in a 54% reduction in time to diagnosis compared with MPI (median 2.9 h [25th to 75th percentile: 2.1 to 4.0 h] vs. 6.3 h [25th to 75th percentile: 4.2 to 19.0 h], p < 0.0001). Costs of care were 38% lower compared with standard (median $2,137 [25th to 75th percentile: $1,660 to $3,077] vs. $3,458 [25th to 75th percentile: $2,900 to $4,297], p < 0.0001). The diagnostic strategies had no difference in major adverse cardiac events after normal index testing (0.8% in the CCTA arm vs. 0.4% in the MPI arm, p = 0.29). CONCLUSIONS In emergency department acute, low-risk chest pain patients, the use of CCTA results in more rapid and cost-efficient safe diagnosis than rest-stress MPI. Further studies comparing CCTA to other diagnostic strategies are needed to optimize evaluation of specific patient subsets. (Coronary Computed Tomographic Angiography for Systematic Triage of Acute Chest Pain Patients to Treatment [CT-STAT]; NCT00468325).
منابع مشابه
Coronary CT angiography in acute chest pain
Coronary computed tomographic angiography has become a reliable diagnostic tool in the evaluation of patients with chest pain. Studies have shown this modality to be accurate and safe when compared with conventional methods of assessing patients with chest pain. We review the recent developments with coronary computed tomographic angiography and devote particular attention toward its applicatio...
متن کاملCoronary CT angiography versus standard emergency department evaluation for acute chest pain and diabetic patients: Is there benefit with early coronary CT angiography? Results of the randomized comparative effectiveness ROMICAT II trial
Coronary CT angiography versus standard emergency department evaluation for acute chest pain and diabetic patients: Is there benefit with early coronary CT angiography? Results of the randomized comparative effectiveness ROMICAT II trialCoronary CT angiography versus standard emergency department evaluation for acute chest pain and diabetic patients: Is there benefit with early coronary CT angi...
متن کاملCurrent Concepts in Cardiac CT Angiography for Patients With Acute Chest Pain
This article presents specific examples of delayed diagnosis of acute coronary syndrome, acute aortic dissection, and pulmonary embolism resulting from evaluating patients with nonspecific acute chest pain who did not undergo immediate dedicated coronary CT angiography (CTA) or triple rule-out protocol (TRO). These concrete examples of delayed diagnosis may advance the concept of using cardiac ...
متن کاملDiagnostic utility of Computed Tomography Angiography (CTA) in the triage of patients with acute chest pain of suspected cardiac origin: An overview and a critical appraisal of a recently conducted systematic review and meta-analysis
The current text provides a brief overview and a methodological appraisal of the systematic review and metaanalysis conducted by Samad and colleagues (2012) who assessed the clinical utility and diagnostic accuracy of CTA for the diagnosis of acute coronary syndrome (ACS) in low to intermediate risk patients presenting to the emergency department (ED) with acute chest pain of suspected cardiac ...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Journal of the American College of Cardiology
دوره 58 14 شماره
صفحات -
تاریخ انتشار 2011