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.
N1 - Funding Information:
Hospital of the University of Pennsylvania: Site Investigators: Judd E. Hollander, MD, Harold I. Litt, MD, PhD; Research Coordinators: Emily Barrows, Jeffrey Le, Shannon Marcoon, Julie Pitts, RN, Scott Steingall, RT Pennsylvania State University Medical Center at Hershey: Site Investigators: James M. Leaming, MD, Harjit Singh, MD, Michelle A. Fischer, MD, Steven Ettinger, MD, Carlos Jamis-Dow, MD, Kevin Moser, MD; Research Coordinators: Swati Shah, Kevin Gardner, RN, Russell Dicristina, Susan Oskorus Penn Presbyterian Medical Center: Site Investigators: Laurence Gavin, MD, Anna Marie Chang, MD, Judd E. Hollander, MD, Harold I. Litt, MD, PhD; Research Coordinators: Christopher Decker, Michael Green, Katie O’Conor, Angela Roach, Scott Steingall, RT, Kristy Walsh, Max Wayne Wake Forest University: Site Investigators: J. Jeffrey Carr, MD, MSc, Daniel W. Entrikin, MD, Kim Askew, MD, James W. Hoekstra, MD, Simon Mahler, MD, Chadwick D. Miller, MD, MS; Research Coordinators: Denise Boyles, Stephanie Bradshaw, Mark Collin, Erin Harper, Lisa Hinshaw, MS, Jane Kilkenny, Megan Koonts, Lori Triplett, RN University of Pittsburgh Medical Center: Site Investigators: Charissa B. Pacella, MD, Joan M. Lacomis, MD, Christopher R. Deible, MD, PhD; Research Coordinators: Sara Vandruff, Barbara Early, Tina Vita, Dawn McBride Brown University: Biostatistical and research design support from Constantine Gatsonis, PhD, Brad Snyder, MS, Sanaa Boudhar, MS, Patricia Fox, MS, Erin Greco, MS Data and Safety Monitoring Board: David Bluemke, MD, PhD (Chair), National Institutes of Health, Bethesda, MD; Todd A. Alonzo, PhD, University of Southern California, Arcadia, CA; Jon F. Merz, MBA, JD, PhD, University of Pennsylvania, Philadelphia, PA; Herbert Y. Kressel, MD, Beth Israel Deaconess Medical Center, Boston, MA Adjudication Committee: W. Frank Peacock, MD, Cleveland Clinic, OH; Robert Hendel, MD, University of Miami, FL
Publisher Copyright:
© 2015 American College of Emergency Physicians.
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.
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U2 - 10.1016/j.annemergmed.2015.09.014
DO - 10.1016/j.annemergmed.2015.09.014
M3 - Article
C2 - 26507904
AN - SCOPUS:84951086883
SN - 0196-0644
VL - 67
SP - 460-468.e1
JO - Journal of the American College of Emergency Physicians
JF - Journal of the American College of Emergency Physicians
IS - 4
ER -