Megan Tooley, Cardiovascular Roundtable
As previously discussed in Cardiovascular Rounds, a number of recent studies have evaluated the overall costs and downstream impact of coronary CT angiography (CCTA) in various patient populations.
Adding to this list is the ROMICAT II (Rule Out Myocardial Infarction Using Computer Assisted Tomography) trial. The study assessed if using CCTA as a first diagnostic test in the emergency department (ED) to rule out acute coronary syndrome (ACS) in low-to-intermediate risk patients is more effective than standard evaluation.
The trial results, published in the New England Journal of Medicine on July 26, further validate the utility of CCTA as a safe alternative to nuclear imaging for certain patients presenting to the ED with chest pain. While overall costs, including all subsequent downstream services, were modestly higher in the CCTA group on average, the efficiency gains from a CCTA-based diagnostic strategy are promising.
Overall, more patients were discharged from the ED with fewer admissions to an observation unit among those receiving CCTA compared to standard evaluation.
ROMICAT II: CCTA is safe and efficient in the ED, but not a cost cutter
The results of the highly anticipated CT-STAT trial were released this week in the Journal of the American College of Cardiology. The study objective was to compare the efficiency, cost, and safety of coronary CT angiography to rest-stress myocardial perfusion imaging to diagnose coronary artery disease (CAD) for emergent low-risk patients. Overall, CCTA was found to be more efficient and less costly than traditional SPECT imaging in the diagnostic work-up of this patient subset. While helping to further validate the role of CCTA to expedite care for appropriate chest pain patients, the study raises new questions about future opportunities for CCTA, and if it can supplant more established tests for diagnosing and ruling-out CAD.
Latest CT-STAT Results Point to Value of Coronary CTA