Coronary Computed Tomography Angiography Versus Stress Echocardiography in Acute Chest Pain

Levsky, Jeffrey M.; Haramati, Linda B.; Spevack, Daniel M.; Menegus, Mark; Chen, Terence; Mizrachi, Sarah; Brown-Manhertz, Durline; Selesny, Samantha; Lerer, Rikah; White, Deborah; Taub, Cynthia C.; García, Mario J.

doi:10.1016/j.jcmg.2018.03.024

Cited by 35 publications

(19 citation statements)

References 42 publications

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“…A single-center randomized control study of 400 consecutive participants comparing coronary artery CT with stress echocardiography for early emergency room discharge of low-to intermediate-risk patients documented a smaller percentage of patients being hospitalized, the primary endpoint, and shorter duration of emergency room observation or hospitalization for stress echocardiography. Major adverse cardiac events at 24 months were comparable for the modalities [24].…”

Section: Discussion Of Procedures By Variantmentioning

confidence: 83%

ACR Appropriateness Criteria® Acute Nonspecific Chest Pain-Low Probability of Coronary Artery Disease

Beache

Mohammed

Koweek

et al. 2020

Journal of the American College of Radiology

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Patients with acute nonspecific chest pain and low probability for coronary disease remain an important clinical management dilemma. We focus on evidence for imaging, in an integrated decision-making setting. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

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Section: Discussion Of Procedures By Variantmentioning

confidence: 83%

ACR Appropriateness Criteria® Acute Nonspecific Chest Pain-Low Probability of Coronary Artery Disease

Beache

Mohammed

Koweek

et al. 2020

Journal of the American College of Radiology

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“…Levsky et al enrolled 400 patients without known CAD presenting with chest pain to the emergency department and showed that ESE and CCTA led to similar results in major adverse cardiac events (MACE), invasive angiography, and revascularization by one year. Patients in the CCTA arm were admitted more often and spent more days in the hospital than the patients in the ESE group [13].…”

Section: Discussionmentioning

confidence: 93%

Comparing downstream consequences of normal exercise stress echocardiograms and cardiac computed tomography angiography scans in patients suspected of having of obstructive coronary artery disease: a retrospective cohort study of Tricare beneficiaries

Madigan

Adams

Chu

et al. 2021

Int J Cardiovasc Imaging

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To compare overall number of downstream tests and total costs between negative exercise stress echocardiograms (ESE) or cardiac computed tomography angiography scans (CCTA) in symptomatic Tricare beneficiaries suspected of having coronary artery disease (CAD). This is a retrospective cohort study examining 651 propensity-matched patients who underwent ESE or CCTA with normal results between 2008 and 2014 at the United States’ largest Department of Defense hospital. The total number of additional downstream tests over the next five years was determined. The total costs associated with each arm, inclusive of the initial test and all subsequent tests, were calculated using the 2018 Medicare Physician Fee Schedule. 18.5 percent of patients with a normal ESE result underwent some additional form of cardiac testing over the five years after initial testing compared to 12.8 percent of patients with a normal CCTA. The absolute difference in total number of downstream tests between both study groups was 5.7 percent (p = 0.03). When factoring the costs of the initial test as well as the downstream tests, the ESE group was associated with overall lower costs compared to the CCTA group, 351 United States Dollars (USD) versus 496 USD (p < 0.0001). This study demonstrates that, when compared to CCTA, ESE is associated with a higher total number of downstream tests, but overall lower total costs when chosen as initial testing strategy for suspected CAD.

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“…Desde então, estudos sugerem que pacientes com escore intermediário (3 e 4) deveriam ter os níveis de troponina medidos e submetidos a um teste isquêmico provocativo sempre que possível. 8,12 Nossos resultados também sugerem que é uma melhor avaliação da presença de doença coronariana por meio de teste não invasivo além das medidas de troponina nessa população.…”

Section: Discussionunclassified

Desempenho Diagnóstico da Angiotomografia Computadorizada e da Avaliação Seriada de Troponina Cardíaca Sensível em Pacientes com Dor Torácica e Risco Intermediário para Eventos Cardiovasculares

Soeiro¹,

Biselli²,

Leal³

et al. 2021

Arquivos Brasileiros De Cardiologia

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Fundamento: A angiotomografia coronária (ATC) tem sido usada para avaliação de dor torácica principalmente em pacientes de baixo risco, e poucos dados existem com pacientes em risco intermediário. Objetivo: Avaliar o desempenho de medidas seriadas de troponinas sensíveis e de ATC em pacientes de risco intermediário. Métodos: Um total de 100 pacientes com dor torácica, TIMI score 3 ou 4 e troponina negativa foram prospectivamente incluídos. Todos os pacientes foram submetidos à ATC, e aqueles com obstruções ≥ 50% foram encaminhados à cineangiocoronariografia. Pacientes com lesões < 50% recebiam alta hospitalar, receberam alta e foram contatados 30 dias depois por telefonema para avaliação dos desfechos clínicos. Os desfechos foram hospitalização, morte, e infarto agudo do miocárdio em 30 dias. A comparação entre os métodos foi realizada pelo teste de concordância kappa. O desempenho das medidas de troponina e da ATC na detecção de lesões coronárias significativas e desfechos clínicos foi calculado. Os resultados foram considerados estatisticamente significativos quando p <0,05.Resultados: Estenose coronária ≥ 50% na ATC foi encontrada em 38% dos pacientes e lesões coronárias significativas na angiografia coronária foram encontradas em 31 pacientes. Dois eventos clínicos foram observados. A análise de concordância Kappa mostrou baixa concordância entre as medidas de troponina e ATC na detecção de lesões coronárias significativas (kappa = 0,022, p = 0,78). O desempenho da ATC para detectar lesões coronárias significativas na angiografia coronária ou para prever eventos clínicos em 30 dias foi melhor que as medidas de troponina sensível (acurácia de 91% versus 60%).Conclusão: ATC teve melhor desempenho que as medidas seriadas de troponina na detecção de doença coronariana significativa em pacientes com dor torácica e risco intermediário para eventos cardiovasculares.

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Coronary Computed Tomography Angiography Versus Stress Echocardiography in Acute Chest Pain

Cited by 35 publications

References 42 publications

ACR Appropriateness Criteria® Acute Nonspecific Chest Pain-Low Probability of Coronary Artery Disease

ACR Appropriateness Criteria® Acute Nonspecific Chest Pain-Low Probability of Coronary Artery Disease

Comparing downstream consequences of normal exercise stress echocardiograms and cardiac computed tomography angiography scans in patients suspected of having of obstructive coronary artery disease: a retrospective cohort study of Tricare beneficiaries

Desempenho Diagnóstico da Angiotomografia Computadorizada e da Avaliação Seriada de Troponina Cardíaca Sensível em Pacientes com Dor Torácica e Risco Intermediário para Eventos Cardiovasculares

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