Decision Analytic Model for Evaluation of Suspected Coronary Disease with Stress Testing and Coronary CT Angiography

Cheaper, better, or good enough: Evidentiary standards for coronary CTA

“…Comparison with a currently accepted standard of care, an MPS testing-based strategy, in an appropriate population makes their results clinically relevant. The finding of cost savings with CCTA-based strategies is consistent with previously published work, including retrospective studies and decision analytic models of patients with stable chest pain, [9][10][11][12] patients with chest pain in an emergency department setting, 9,13,14 and asymptomatic patients with positive stress tests otherwise referred to invasive angiography, 15 which have shown lower costs or improved outcomes or both with CCTAbased strategies. The reporting by Cheezum et al 8 of incidental findings and downstream evaluation of such addresses an important difference between the two testing strategies which has not always been considered.…”

Coronary Computed Tomography Angiography After Stress Testing

“…In this circumstance, the low diagnostic yield of elective ICA is not justified by increased costs and by the small but definite risk of complications (6). As a preferred strategy, CCTA may be utilized for further risk stratification and prudent patient selection for ICA, with overall lowered costs and radiation exposure (20,21). A commonly encountered clinical scenario is that of asymptomatic patients with abnormal stress tests.…”

Cardiac risk factors and risk scores vs cardiac computed tomography angiography: a prospective cohort study for triage of ED patients with acute chest pain

“…Based upon costeffectiveness considerations, further non-invasive testing for CAD is unlikely to be cost effective when the probability of significant CAD drops below 1% or rises close to 50%. 19 Power calculations were performed assuming a two sample comparison of proportions using a twosided test with an alpha of 0.05. For a risk factor present in 50% of the study population, a sample size of 250 is calculated to provide 80% power to detect a reduction in CAD rate from 10% to 1%, and 85% power to detect an increase in CAD rate above 25%.…”

“…16,17,18 These randomized multicenter studies have opened the possibility of widespread cCTA testing for low risk ED patients presenting with chest pain, though the utility of such testing depends upon the pre-test probability of disease. 19 Many practicing physicians remain convinced that accurate evaluation of traditional risk factors and clinical presentation can be used for triage of the low risk ED patient and to limit the number of ED patients who should be referred for cCTA. The purpose of the current study was to evaluate individual conventional cardiac risk factors, as well two widely accepted risk scores -TIMI and GRACE -for prediction of coronary artery disease (CAD) and adverse outcomes in an ED population judged to be at low to intermediate risk for ACS.…”