Impact of coronary calcification on clinical management in patients with acute chest pain

Daniel O. Bittner, Thomas Mayrhofer, Fabian Bamberg, Travis R. Hallett, Sumbal Janjua, Daniel Addison, John T. Nagurney, James E. Udelson, Michael T. Lu, Quynh A. Truong, Pamela K. Woodard, Judd E. Hollander, Chadwick Miller, Anna Marie Chang, Harjit Singh, Harold Litt, Udo Hoffmann, Maros Ferencik

Research output: Contribution to journalArticle

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Abstract

Background-Coronary artery calcification (CAC) may impair diagnostic assessment of coronary computed tomography angiography (CTA). We determined whether CAC affects efficiency of coronary CTA in patients with suspected acute coronary syndrome (ACS). Methods and Results-This is a pooled analysis of ACRIN-PA (American College of Radiology Imaging Network- Pennsylvania) 4005 and the ROMICAT-II trial (Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography) comparing an initial coronary CTA strategy to standard of care in acute chest pain patients. In the CTA arms, we investigated appropriateness of downstream testing, cost, and diagnostic yield to identify patients with obstructive coronary artery disease on subsequent invasive coronary angiography across CAC score strata (Agatston score: 0, >0-10, >10-100, >100-400, >400). Out of 1234 patients (mean age 51±8.8 years), 80 (6.5%) had obstructive coronary artery disease (=70% stenosis) and 68 (5.5%) had ACS. Prevalence of obstructive coronary artery disease (1%-64%), ACS (1%-44%), downstream testing (4%-72%), and total (2337-8484 US$) and diagnostic cost (2310-6678 US$) increased across CAC strata (P<0.001). As the increase in testing and cost were lower than the increase of ACS rate in patients with CAC>400, cost to diagnose one ACS was lowest in this group (19 283 US$ versus 464 399 US$) as compared with patients without CAC. The diagnostic yield of invasive coronary angiography was highest in patients with CAC>400 (87% versus 38%). Conclusions-Downstream testing, total, and diagnostic cost increased with increasing CAC, but were found to be appropriate because obstructive coronary artery disease and ACS were more prevalent in patients with high CAC. In patients with acute chest pain undergoing coronary CTA, cost-efficient testing and excellent diagnostic yield can be achieved even with high CAC burden.

Original languageEnglish (US)
Article numbere005893
JournalCirculation: Cardiovascular Imaging
Volume10
Issue number5
DOIs
StatePublished - May 1 2017

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Acute Pain
Chest Pain
Coronary Vessels
Acute Coronary Syndrome
Coronary Artery Disease
Costs and Cost Analysis
Coronary Angiography
Standard of Care
Radiology
Myocardial Ischemia
Pathologic Constriction
Myocardial Infarction
Tomography
Computed Tomography Angiography

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Bittner, D. O., Mayrhofer, T., Bamberg, F., Hallett, T. R., Janjua, S., Addison, D., ... Ferencik, M. (2017). Impact of coronary calcification on clinical management in patients with acute chest pain. Circulation: Cardiovascular Imaging, 10(5), [e005893]. https://doi.org/10.1161/CIRCIMAGING.116.005893
Bittner, Daniel O. ; Mayrhofer, Thomas ; Bamberg, Fabian ; Hallett, Travis R. ; Janjua, Sumbal ; Addison, Daniel ; Nagurney, John T. ; Udelson, James E. ; Lu, Michael T. ; Truong, Quynh A. ; Woodard, Pamela K. ; Hollander, Judd E. ; Miller, Chadwick ; Chang, Anna Marie ; Singh, Harjit ; Litt, Harold ; Hoffmann, Udo ; Ferencik, Maros. / Impact of coronary calcification on clinical management in patients with acute chest pain. In: Circulation: Cardiovascular Imaging. 2017 ; Vol. 10, No. 5.
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title = "Impact of coronary calcification on clinical management in patients with acute chest pain",
abstract = "Background-Coronary artery calcification (CAC) may impair diagnostic assessment of coronary computed tomography angiography (CTA). We determined whether CAC affects efficiency of coronary CTA in patients with suspected acute coronary syndrome (ACS). Methods and Results-This is a pooled analysis of ACRIN-PA (American College of Radiology Imaging Network- Pennsylvania) 4005 and the ROMICAT-II trial (Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography) comparing an initial coronary CTA strategy to standard of care in acute chest pain patients. In the CTA arms, we investigated appropriateness of downstream testing, cost, and diagnostic yield to identify patients with obstructive coronary artery disease on subsequent invasive coronary angiography across CAC score strata (Agatston score: 0, >0-10, >10-100, >100-400, >400). Out of 1234 patients (mean age 51±8.8 years), 80 (6.5{\%}) had obstructive coronary artery disease (=70{\%} stenosis) and 68 (5.5{\%}) had ACS. Prevalence of obstructive coronary artery disease (1{\%}-64{\%}), ACS (1{\%}-44{\%}), downstream testing (4{\%}-72{\%}), and total (2337-8484 US$) and diagnostic cost (2310-6678 US$) increased across CAC strata (P<0.001). As the increase in testing and cost were lower than the increase of ACS rate in patients with CAC>400, cost to diagnose one ACS was lowest in this group (19 283 US$ versus 464 399 US$) as compared with patients without CAC. The diagnostic yield of invasive coronary angiography was highest in patients with CAC>400 (87{\%} versus 38{\%}). Conclusions-Downstream testing, total, and diagnostic cost increased with increasing CAC, but were found to be appropriate because obstructive coronary artery disease and ACS were more prevalent in patients with high CAC. In patients with acute chest pain undergoing coronary CTA, cost-efficient testing and excellent diagnostic yield can be achieved even with high CAC burden.",
author = "Bittner, {Daniel O.} and Thomas Mayrhofer and Fabian Bamberg and Hallett, {Travis R.} and Sumbal Janjua and Daniel Addison and Nagurney, {John T.} and Udelson, {James E.} and Lu, {Michael T.} and Truong, {Quynh A.} and Woodard, {Pamela K.} and Hollander, {Judd E.} and Chadwick Miller and Chang, {Anna Marie} and Harjit Singh and Harold Litt and Udo Hoffmann and Maros Ferencik",
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Bittner, DO, Mayrhofer, T, Bamberg, F, Hallett, TR, Janjua, S, Addison, D, Nagurney, JT, Udelson, JE, Lu, MT, Truong, QA, Woodard, PK, Hollander, JE, Miller, C, Chang, AM, Singh, H, Litt, H, Hoffmann, U & Ferencik, M 2017, 'Impact of coronary calcification on clinical management in patients with acute chest pain', Circulation: Cardiovascular Imaging, vol. 10, no. 5, e005893. https://doi.org/10.1161/CIRCIMAGING.116.005893

Impact of coronary calcification on clinical management in patients with acute chest pain. / Bittner, Daniel O.; Mayrhofer, Thomas; Bamberg, Fabian; Hallett, Travis R.; Janjua, Sumbal; Addison, Daniel; Nagurney, John T.; Udelson, James E.; Lu, Michael T.; Truong, Quynh A.; Woodard, Pamela K.; Hollander, Judd E.; Miller, Chadwick; Chang, Anna Marie; Singh, Harjit; Litt, Harold; Hoffmann, Udo; Ferencik, Maros.

In: Circulation: Cardiovascular Imaging, Vol. 10, No. 5, e005893, 01.05.2017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Impact of coronary calcification on clinical management in patients with acute chest pain

AU - Bittner, Daniel O.

AU - Mayrhofer, Thomas

AU - Bamberg, Fabian

AU - Hallett, Travis R.

AU - Janjua, Sumbal

AU - Addison, Daniel

AU - Nagurney, John T.

AU - Udelson, James E.

AU - Lu, Michael T.

AU - Truong, Quynh A.

AU - Woodard, Pamela K.

AU - Hollander, Judd E.

AU - Miller, Chadwick

AU - Chang, Anna Marie

AU - Singh, Harjit

AU - Litt, Harold

AU - Hoffmann, Udo

AU - Ferencik, Maros

PY - 2017/5/1

Y1 - 2017/5/1

N2 - Background-Coronary artery calcification (CAC) may impair diagnostic assessment of coronary computed tomography angiography (CTA). We determined whether CAC affects efficiency of coronary CTA in patients with suspected acute coronary syndrome (ACS). Methods and Results-This is a pooled analysis of ACRIN-PA (American College of Radiology Imaging Network- Pennsylvania) 4005 and the ROMICAT-II trial (Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography) comparing an initial coronary CTA strategy to standard of care in acute chest pain patients. In the CTA arms, we investigated appropriateness of downstream testing, cost, and diagnostic yield to identify patients with obstructive coronary artery disease on subsequent invasive coronary angiography across CAC score strata (Agatston score: 0, >0-10, >10-100, >100-400, >400). Out of 1234 patients (mean age 51±8.8 years), 80 (6.5%) had obstructive coronary artery disease (=70% stenosis) and 68 (5.5%) had ACS. Prevalence of obstructive coronary artery disease (1%-64%), ACS (1%-44%), downstream testing (4%-72%), and total (2337-8484 US$) and diagnostic cost (2310-6678 US$) increased across CAC strata (P<0.001). As the increase in testing and cost were lower than the increase of ACS rate in patients with CAC>400, cost to diagnose one ACS was lowest in this group (19 283 US$ versus 464 399 US$) as compared with patients without CAC. The diagnostic yield of invasive coronary angiography was highest in patients with CAC>400 (87% versus 38%). Conclusions-Downstream testing, total, and diagnostic cost increased with increasing CAC, but were found to be appropriate because obstructive coronary artery disease and ACS were more prevalent in patients with high CAC. In patients with acute chest pain undergoing coronary CTA, cost-efficient testing and excellent diagnostic yield can be achieved even with high CAC burden.

AB - Background-Coronary artery calcification (CAC) may impair diagnostic assessment of coronary computed tomography angiography (CTA). We determined whether CAC affects efficiency of coronary CTA in patients with suspected acute coronary syndrome (ACS). Methods and Results-This is a pooled analysis of ACRIN-PA (American College of Radiology Imaging Network- Pennsylvania) 4005 and the ROMICAT-II trial (Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography) comparing an initial coronary CTA strategy to standard of care in acute chest pain patients. In the CTA arms, we investigated appropriateness of downstream testing, cost, and diagnostic yield to identify patients with obstructive coronary artery disease on subsequent invasive coronary angiography across CAC score strata (Agatston score: 0, >0-10, >10-100, >100-400, >400). Out of 1234 patients (mean age 51±8.8 years), 80 (6.5%) had obstructive coronary artery disease (=70% stenosis) and 68 (5.5%) had ACS. Prevalence of obstructive coronary artery disease (1%-64%), ACS (1%-44%), downstream testing (4%-72%), and total (2337-8484 US$) and diagnostic cost (2310-6678 US$) increased across CAC strata (P<0.001). As the increase in testing and cost were lower than the increase of ACS rate in patients with CAC>400, cost to diagnose one ACS was lowest in this group (19 283 US$ versus 464 399 US$) as compared with patients without CAC. The diagnostic yield of invasive coronary angiography was highest in patients with CAC>400 (87% versus 38%). Conclusions-Downstream testing, total, and diagnostic cost increased with increasing CAC, but were found to be appropriate because obstructive coronary artery disease and ACS were more prevalent in patients with high CAC. In patients with acute chest pain undergoing coronary CTA, cost-efficient testing and excellent diagnostic yield can be achieved even with high CAC burden.

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U2 - 10.1161/CIRCIMAGING.116.005893

DO - 10.1161/CIRCIMAGING.116.005893

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