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  • Diagnostic performance and cost of CT angiography versus stress ECG — A randomized prospective study of suspected acute coronary syndrome chest pain in the emergency department (CT-COMPARE)

    Author(s)
    Hamilton-Craig, Christian
    Fifoot, Allison
    Hansena, Mark
    Pincus, Matthew
    Chan, Jonathan
    Walters, Darren L
    Branch, Kelley R
    Griffith University Author(s)
    Chan, Jonathan H.
    Year published
    2014
    Metadata
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    Abstract
    Background Coronary CT angiography (CCTA) has high sensitivity, with 3 recent randomized trials favorably comparing CCTA to standard-of-care. Comparison to exercise stress ECG (ExECG), the most available and least expensive standard-of-care worldwide, has not been systematically tested. Methods CT-COMPARE was a randomized, single-center trial of low-intermediate risk chest pain subjects undergoing CCTA or ExECG after the first negative troponin. From March 2010 to April 2011, 562 patients randomized to either dual-source CCTA (n = 322) or ExECG (n = 240). Primary endpoints were diagnostic performance for ACS, and hospital ...
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    Background Coronary CT angiography (CCTA) has high sensitivity, with 3 recent randomized trials favorably comparing CCTA to standard-of-care. Comparison to exercise stress ECG (ExECG), the most available and least expensive standard-of-care worldwide, has not been systematically tested. Methods CT-COMPARE was a randomized, single-center trial of low-intermediate risk chest pain subjects undergoing CCTA or ExECG after the first negative troponin. From March 2010 to April 2011, 562 patients randomized to either dual-source CCTA (n = 322) or ExECG (n = 240). Primary endpoints were diagnostic performance for ACS, and hospital cost at 30 days. Secondary endpoints were time-to-discharge, admission rates, and downstream resource utilization. Results ACS occurred in 24 (4%) patients. ExECG had 213 negative studies and 27 (26%) positive studies for ACS with sensitivity of 83% [95% CI: 36, 99.6%], specificity of 91% [CI: 86, 94%], and ROC AUC of 0.87 [CI: 0.70, 1]. CCTA (> 50% stenosis considered positive) had 288 negative studies and 18/35 (51%) positive studies with a sensitivity of 100% [CI: 81.5, 100], specificity of 94% [CI: 91.2, 96.7%], and ROC of 0.97 [CI: 0.92, 1.0; p = 0.2]. Despite CCTA having higher odds of downstream testing (OR 2.0), 30 day per-patient cost was significantly lower for CCTA ($2193 vs $2704, p < 0.001). Length of stay for CCTA was significantly reduced (13.5 h [95% CI: 11.2-15.7], ExECG 19.7 h [95% CI: 17.4-22.1], p < 0.0005), which drove the reduction in cost. No patient had post-discharge cardiovascular events at 30 days. Conclusions CCTA had improved diagnostic performance compared to ExECG, combined with 35% relative reduction in length-of-stay, and 20% reduction in hospital costs. These data lend further evidence that CCTA is useful as a first line assessment in emergency department chest pain.
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    Journal Title
    International Journal of Cardiology
    Volume
    177
    Issue
    3
    DOI
    https://doi.org/10.1016/j.ijcard.2014.10.090
    Subject
    Cardiovascular medicine and haematology
    Publication URI
    http://hdl.handle.net/10072/67188
    Collection
    • Journal articles

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