Coronary Computed Tomography Angiography Versus Radionuclide Myocardial Perfusion Imaging in Patients With Chest Pain Admitted to Telemetry

• DOI: 10.7326/m14-2948
• Publication Date: 2015-06-08T22:30:58Z
• Authors: Jeffrey M. Levsky; Daniel M. Spevack; Mark I. Travin; Mark A. Menegus; Paul W. Huang; Elana T. Clark; Choo-won Kim; Esther Hirschhorn; Katherine D. Freeman; Jonathan N. Tobin; Linda B. Haramati
• Keywords: Cardiac catheterization

The role of coronary computed tomography angiography (CCTA) in the management symptomatic patients suspected having artery disease is expanding. However, prospective intermediate-term outcomes are lacking.To compare CCTA with conventional noninvasive testing.Randomized, controlled comparative effectiveness trial. (ClinicalTrials.gov: NCT00705458).Telemetry-monitored wards an inner-city medical center.400 acute chest pain (mean age, 57 years); 63% women; 54% Hispanic and 37% African-American; low socioeconomic status.CCTA or radionuclide stress myocardial perfusion imaging (MPI).The primary outcome was cardiac catheterization not leading to revascularization within 1 year. Secondary included length stay, resource utilization, patient experience. Safety death, major cardiovascular events, radiation exposure.Thirty (15%) who had 32 (16%) MPI underwent Fifteen (7.5%) 20 (10%) these patients, respectively, did undergo (difference, -2.5 percentage points [95% CI, -8.6 3.5 points]; hazard ratio, 0.77 [CI, 0.40 1.49]; P = 0.44). Median stay 28.9 hours for group 30.4 (P 0.057). follow-up 40.4 months. For groups, incidence death (0.5% versus 3%; 0.12), nonfatal events (4.5% 4.5%), rehospitalization (43% 49%), emergency department visit (63% 58%), outpatient cardiology (23% 21%) differ. Long-term, all-cause exposure lower (24 29 mSv; < 0.001). More graded their experience favorably 0.001) would examination again 0.003).This a single-site study, depended on clinical decisions.The groups significantly differ utilization over 40 Compared MPI, associated less more positive experience.American Heart Association.