Coronary Computed Tomography Angiography Versus Traditional Care

Comparison of One-Year Outcomes and Resource Use

Judd E. Hollander, Constantine Gatsonis, Erin M. Greco, Bradley S. Snyder, Anna Marie Chang, Chadwick D. Miller, Harjit Singh, Harold I. Litt

Research output: Contribution to journalArticle

Abstract

Study objective Three large, multicenter, randomized, clinical trials have shown that coronary computed tomography (CT) angiography allows efficient evaluation and safe discharge of patients with low- to intermediate-risk chest pain who present to the emergency department (ED). We report 1-year event rates and resource use from the American College of Radiology Imaging Network-Pennsylvania 4005 multicenter trial. Methods Patients with low- to intermediate-risk chest pain and presenting to the ED were randomized in a 2:1 ratio to a coronary CT angiography care pathway or traditional care. Subjects were contacted by telephone at least 1 year after ED presentation. Medical record review was performed for all cardiac hospitalizations, procedures and diagnostic tests, and adverse cardiac events. Our main outcome was the composite of cardiac death and myocardial infarction within 1 year. The secondary outcome was resource use. Results One thousand three hundred sixty-eight patients enrolled and 1,285 (94%) had direct participant or proxy contact at 1 year. All others had record review or death index search. From index presentation through 1 year, there was no difference between patients in the coronary CT angiography arm versus traditional care with respect to major adverse cardiac event (1.4% versus 1.1%; difference 0.3%; 95% CI -5.5% to 6.0%). From hospital discharge through 1 year, there was also no difference in ED revisits (36% versus 38%; difference -2.1%; 95% CI -7.9% to 3.7%), hospital admissions (16% versus 17%; difference -0.9%; 95% CI -6.7% to 4.9%), or subsequent cardiac testing (13% versus 13%; difference -0.4%; 95% CI -6.2% to 5.5%). One of 640 subjects with a negative coronary CT angiography result had a major adverse cardiac event within 1 year of presentation (0.16%; 95% CI 0.004% to 0.87%). Conclusion A coronary CT angiography-based strategy for evaluation of patients with low- to intermediate-risk chest pain who present to the ED does not result in increased resource use during 1 year. A negative coronary CT angiography result is associated with a less than 1% major adverse cardiac event rate during the first year after testing.

Original languageEnglish (US)
Pages (from-to)460-468.e1
JournalAnnals of Emergency Medicine
Volume67
Issue number4
DOIs
StatePublished - Apr 1 2016
Externally publishedYes

Fingerprint

Hospital Emergency Service
Chest Pain
Patient Discharge
Proxy
Routine Diagnostic Tests
Telephone
Radiology
Multicenter Studies
Medical Records
Computed Tomography Angiography
Hospitalization
Randomized Controlled Trials
Myocardial Infarction

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Hollander, J. E., Gatsonis, C., Greco, E. M., Snyder, B. S., Chang, A. M., Miller, C. D., ... Litt, H. I. (2016). Coronary Computed Tomography Angiography Versus Traditional Care: Comparison of One-Year Outcomes and Resource Use. Annals of Emergency Medicine, 67(4), 460-468.e1. https://doi.org/10.1016/j.annemergmed.2015.09.014

Coronary Computed Tomography Angiography Versus Traditional Care : Comparison of One-Year Outcomes and Resource Use. / Hollander, Judd E.; Gatsonis, Constantine; Greco, Erin M.; Snyder, Bradley S.; Chang, Anna Marie; Miller, Chadwick D.; Singh, Harjit; Litt, Harold I.

In: Annals of Emergency Medicine, Vol. 67, No. 4, 01.04.2016, p. 460-468.e1.

Research output: Contribution to journalArticle

Hollander, Judd E. ; Gatsonis, Constantine ; Greco, Erin M. ; Snyder, Bradley S. ; Chang, Anna Marie ; Miller, Chadwick D. ; Singh, Harjit ; Litt, Harold I. / Coronary Computed Tomography Angiography Versus Traditional Care : Comparison of One-Year Outcomes and Resource Use. In: Annals of Emergency Medicine. 2016 ; Vol. 67, No. 4. pp. 460-468.e1.
@article{15299befe505448499e6c6dc8beb8231,
title = "Coronary Computed Tomography Angiography Versus Traditional Care: Comparison of One-Year Outcomes and Resource Use",
abstract = "Study objective Three large, multicenter, randomized, clinical trials have shown that coronary computed tomography (CT) angiography allows efficient evaluation and safe discharge of patients with low- to intermediate-risk chest pain who present to the emergency department (ED). We report 1-year event rates and resource use from the American College of Radiology Imaging Network-Pennsylvania 4005 multicenter trial. Methods Patients with low- to intermediate-risk chest pain and presenting to the ED were randomized in a 2:1 ratio to a coronary CT angiography care pathway or traditional care. Subjects were contacted by telephone at least 1 year after ED presentation. Medical record review was performed for all cardiac hospitalizations, procedures and diagnostic tests, and adverse cardiac events. Our main outcome was the composite of cardiac death and myocardial infarction within 1 year. The secondary outcome was resource use. Results One thousand three hundred sixty-eight patients enrolled and 1,285 (94{\%}) had direct participant or proxy contact at 1 year. All others had record review or death index search. From index presentation through 1 year, there was no difference between patients in the coronary CT angiography arm versus traditional care with respect to major adverse cardiac event (1.4{\%} versus 1.1{\%}; difference 0.3{\%}; 95{\%} CI -5.5{\%} to 6.0{\%}). From hospital discharge through 1 year, there was also no difference in ED revisits (36{\%} versus 38{\%}; difference -2.1{\%}; 95{\%} CI -7.9{\%} to 3.7{\%}), hospital admissions (16{\%} versus 17{\%}; difference -0.9{\%}; 95{\%} CI -6.7{\%} to 4.9{\%}), or subsequent cardiac testing (13{\%} versus 13{\%}; difference -0.4{\%}; 95{\%} CI -6.2{\%} to 5.5{\%}). One of 640 subjects with a negative coronary CT angiography result had a major adverse cardiac event within 1 year of presentation (0.16{\%}; 95{\%} CI 0.004{\%} to 0.87{\%}). Conclusion A coronary CT angiography-based strategy for evaluation of patients with low- to intermediate-risk chest pain who present to the ED does not result in increased resource use during 1 year. A negative coronary CT angiography result is associated with a less than 1{\%} major adverse cardiac event rate during the first year after testing.",
author = "Hollander, {Judd E.} and Constantine Gatsonis and Greco, {Erin M.} and Snyder, {Bradley S.} and Chang, {Anna Marie} and Miller, {Chadwick D.} and Harjit Singh and Litt, {Harold I.}",
year = "2016",
month = "4",
day = "1",
doi = "10.1016/j.annemergmed.2015.09.014",
language = "English (US)",
volume = "67",
pages = "460--468.e1",
journal = "Annals of Emergency Medicine",
issn = "0196-0644",
publisher = "Mosby Inc.",
number = "4",

}

TY - JOUR

T1 - Coronary Computed Tomography Angiography Versus Traditional Care

T2 - Comparison of One-Year Outcomes and Resource Use

AU - Hollander, Judd E.

AU - Gatsonis, Constantine

AU - Greco, Erin M.

AU - Snyder, Bradley S.

AU - Chang, Anna Marie

AU - Miller, Chadwick D.

AU - Singh, Harjit

AU - Litt, Harold I.

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Study objective Three large, multicenter, randomized, clinical trials have shown that coronary computed tomography (CT) angiography allows efficient evaluation and safe discharge of patients with low- to intermediate-risk chest pain who present to the emergency department (ED). We report 1-year event rates and resource use from the American College of Radiology Imaging Network-Pennsylvania 4005 multicenter trial. Methods Patients with low- to intermediate-risk chest pain and presenting to the ED were randomized in a 2:1 ratio to a coronary CT angiography care pathway or traditional care. Subjects were contacted by telephone at least 1 year after ED presentation. Medical record review was performed for all cardiac hospitalizations, procedures and diagnostic tests, and adverse cardiac events. Our main outcome was the composite of cardiac death and myocardial infarction within 1 year. The secondary outcome was resource use. Results One thousand three hundred sixty-eight patients enrolled and 1,285 (94%) had direct participant or proxy contact at 1 year. All others had record review or death index search. From index presentation through 1 year, there was no difference between patients in the coronary CT angiography arm versus traditional care with respect to major adverse cardiac event (1.4% versus 1.1%; difference 0.3%; 95% CI -5.5% to 6.0%). From hospital discharge through 1 year, there was also no difference in ED revisits (36% versus 38%; difference -2.1%; 95% CI -7.9% to 3.7%), hospital admissions (16% versus 17%; difference -0.9%; 95% CI -6.7% to 4.9%), or subsequent cardiac testing (13% versus 13%; difference -0.4%; 95% CI -6.2% to 5.5%). One of 640 subjects with a negative coronary CT angiography result had a major adverse cardiac event within 1 year of presentation (0.16%; 95% CI 0.004% to 0.87%). Conclusion A coronary CT angiography-based strategy for evaluation of patients with low- to intermediate-risk chest pain who present to the ED does not result in increased resource use during 1 year. A negative coronary CT angiography result is associated with a less than 1% major adverse cardiac event rate during the first year after testing.

AB - Study objective Three large, multicenter, randomized, clinical trials have shown that coronary computed tomography (CT) angiography allows efficient evaluation and safe discharge of patients with low- to intermediate-risk chest pain who present to the emergency department (ED). We report 1-year event rates and resource use from the American College of Radiology Imaging Network-Pennsylvania 4005 multicenter trial. Methods Patients with low- to intermediate-risk chest pain and presenting to the ED were randomized in a 2:1 ratio to a coronary CT angiography care pathway or traditional care. Subjects were contacted by telephone at least 1 year after ED presentation. Medical record review was performed for all cardiac hospitalizations, procedures and diagnostic tests, and adverse cardiac events. Our main outcome was the composite of cardiac death and myocardial infarction within 1 year. The secondary outcome was resource use. Results One thousand three hundred sixty-eight patients enrolled and 1,285 (94%) had direct participant or proxy contact at 1 year. All others had record review or death index search. From index presentation through 1 year, there was no difference between patients in the coronary CT angiography arm versus traditional care with respect to major adverse cardiac event (1.4% versus 1.1%; difference 0.3%; 95% CI -5.5% to 6.0%). From hospital discharge through 1 year, there was also no difference in ED revisits (36% versus 38%; difference -2.1%; 95% CI -7.9% to 3.7%), hospital admissions (16% versus 17%; difference -0.9%; 95% CI -6.7% to 4.9%), or subsequent cardiac testing (13% versus 13%; difference -0.4%; 95% CI -6.2% to 5.5%). One of 640 subjects with a negative coronary CT angiography result had a major adverse cardiac event within 1 year of presentation (0.16%; 95% CI 0.004% to 0.87%). Conclusion A coronary CT angiography-based strategy for evaluation of patients with low- to intermediate-risk chest pain who present to the ED does not result in increased resource use during 1 year. A negative coronary CT angiography result is associated with a less than 1% major adverse cardiac event rate during the first year after testing.

UR - http://www.scopus.com/inward/record.url?scp=84951086883&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84951086883&partnerID=8YFLogxK

U2 - 10.1016/j.annemergmed.2015.09.014

DO - 10.1016/j.annemergmed.2015.09.014

M3 - Article

VL - 67

SP - 460-468.e1

JO - Annals of Emergency Medicine

JF - Annals of Emergency Medicine

SN - 0196-0644

IS - 4

ER -