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.
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The American College of Cardiology’s (ACC) concluded its 61st annual scientific sessions in Chicago on Tuesday. Two of the most compelling research findings shared at the final session included updates on the effectiveness of CCTA in evaluating chest pain patients and mortality in CABG vs. PCI patients. For additional Roundtable coverage of this year’s ACC sessions, please see here.
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Coronary CT angiography (CCTA) – a non-invasive anatomical imaging study most commonly used to identify possible stenoses in the coronary artery tree – continues to gain greater acceptance as a viable modality to diagnose or rule-out the presence of coronary artery disease (CAD). When compared to well-established techniques such as stress testing and myocardial perfusion imaging, CCTA often demonstrates comparable, if not superior, diagnostic performance. As such, proponents argue CCTA – when used for appropriate patients and indications – can obviate the need for myocardial perfusion imaging and additional testing. In addition, CCTA may result in more efficient care by safely discharging patients with a negative test result who may otherwise undergo cardiac catheterization.
Despite its utility, few studies have examined the impact of CCTA on downstream testing and procedures, and subsequently, health care spending, when compared to standard approaches. This week, two new studies helped to shed light on the impact of CCTA, though the data result in more questions than answers regarding CCTA’s ability to reduce downstream utilization and health care costs.
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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.
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