Document Detail

A randomized controlled trial of multi-slice coronary computed tomography for evaluation of acute chest pain.
MedLine Citation:
PMID:  17320744     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: This study sought to compare the safety, diagnostic efficacy, and efficiency of multi-slice computed tomography (MSCT) with standard diagnostic evaluation of low-risk acute chest pain patients. BACKGROUND: Over 1 million patients have emergency center evaluations for acute chest pain annually, at an estimated diagnostic cost of over $10 billion. Multi-slice computed tomography has a high negative predictive value for exclusion of coronary artery stenoses. METHODS: We randomized patients to MSCT (n = 99) versus SOC (n = 98) protocols. The MSCT patients with minimal disease were discharged; those with stenosis >70% underwent catheterization, whereas cases with intermediate lesions or non-diagnostic scans underwent stress testing. Outcomes included: safety (freedom from major adverse events over 6 months), diagnostic efficacy (clinically correct and definitive diagnosis), as well as time and cost of care. RESULTS: Both approaches were completely (100%) safe. The MSCT alone immediately excluded or identified coronary disease as the source of chest pain in 75% of patients, including 67 with normal coronary arteries and 8 with severe disease referred for invasive evaluation. The remaining 25% of patients required stress testing, owing to intermediate severity lesions or non-diagnostic scans. During the index visit, MSCT evaluation reduced diagnostic time compared with SOC (3.4 h vs. 15.0 h, p < 0.001) and lowered costs (1,586 dollars vs. 1,872 dollars, p < 0.001). Importantly, MSCT patients required fewer repeat evaluations for recurrent chest pain (MSCT, 2 of 99 (2.0%) patients vs. SOC, 7 of 99 (7%) patients; p = 0.10). CONCLUSIONS: Multi-slice computed tomographic coronary angiography can definitively establish or exclude coronary disease as the cause of chest pain. However, inability to determine the physiological significance of intermediate severity coronary lesions and cases with inadequate image quality are present limitations. (Study of Coronary Artery Computed Tomography to Diagnose Emergency Chest Pain CR;; NCT00273832).
James A Goldstein; Michael J Gallagher; William W O'Neill; Michael A Ross; Brian J O'Neil; Gilbert L Raff
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2007-02-12
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  49     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2007 Feb 
Date Detail:
Created Date:  2007-02-26     Completed Date:  2007-03-13     Revised Date:  2007-09-28    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  863-71     Citation Subset:  AIM; IM    
William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
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MeSH Terms
Acute Disease
Chest Pain / etiology,  radiography*
Clinical Protocols
Coronary Angiography / methods*
Decision Support Techniques
Exercise Test / methods
Health Care Costs
Middle Aged
Myocardial Infarction / complications,  diagnosis
Sensitivity and Specificity
Tomography, Spiral Computed / economics,  methods*
Comment In:
J Am Coll Cardiol. 2007 Feb 27;49(8):872-4   [PMID:  17320745 ]
J Am Coll Cardiol. 2007 Aug 14;50(7):650-1; author reply 651   [PMID:  17692754 ]

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