The CT-STAT (Coronary Computed Tomographic Angiography for Systematic Triage of Acute Chest Pain Patients to Treatment) Trial

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• 作者：James A.  ; Goldstein MD^?/sup> ; Kavitha M.  ; Chinnaiyan MD^?/sup> ; Aiden  ; Abidov MD ; PhD^&dagger ; ; Stephan  ; Achenbach MD^&Dagger ; ; Daniel S.  ; Berman MD^§ ; ; Sean W.  ; Hayes MD^§ ; ; Udo  ; Hoffmann MD^?/sup> ; John R.  ; Lesser MD^¶ ; ; Issam A.  ; Mikati MD^# ; Brian J.  ; O'Neil MD^?? ; Leslee J.  ; Shaw PhD^&dagger ; &dagger ; ; Michael Y.H.  ; Shen MD^&Dagger ; &Dagger ; ; Uma S.  ; Valeti MBBS^§ ; § ; ; Gilbert L.  ; Raff MD^?/sup> ;   ; ^{graff@beaumont.edu} ; CT-STAT Investigators
• 关键词：acute chest pain ; coronary computed tomography ; cost of care ; diagnostic effectiveness ; emergency department
• 刊名：Journal of the American College of Cardiology
• 出版年：2011
• 出版时间：27 September 2011
• 年：2011
• 卷：58
• 期：14
• 页码：1414-1422
• 全文大小：752 K

文摘

Objectives

The purpose of this study was to compare the efficiency, cost, and safety of a diagnostic strategy employing early coronary computed tomographic angiography (CCTA) to a strategy employing rest-stress myocardial perfusion imaging (MPI) in the evaluation of acute low-risk chest pain.

Background

In the United States, >8 million patients require emergency department evaluation for acute chest pain annually at an estimated diagnostic cost of >$10 billion.

Methods

This multicenter, randomized clinical trial in 16 emergency departments ran between June 2007 and November 2008. Patients were randomly allocated to CCTA (n = 361) or MPI (n = 338) as the index noninvasive test. The primary outcome was time to diagnosis; the secondary outcomes were emergency department costs of care and safety, defined as freedom from major adverse cardiac events in patients with normal index tests, including 6-month follow-up.

Results

The CCTA resulted in a 54 % reduction in time to diagnosis compared with MPI (median 2.9 h [25th to 75th percentile: 2.1 to 4.0 h] vs. 6.3 h [25th to 75th percentile: 4.2 to 19.0 h], p < 0.0001). Costs of care were 38 % lower compared with standard (median $2,137 [25th to 75th percentile: $1,660 to $3,077] vs. $3,458 [25th to 75th percentile: $2,900 to $4,297], p < 0.0001). The diagnostic strategies had no difference in major adverse cardiac events after normal index testing (0.8 % in the CCTA arm vs. 0.4 % in the MPI arm, p = 0.29).

Conclusions

In emergency department acute, low-risk chest pain patients, the use of CCTA results in more rapid and cost-efficient safe diagnosis than rest-stress MPI. Further studies comparing CCTA to other diagnostic strategies are needed to optimize evaluation of specific patient subsets. (Coronary Computed Tomographic Angiography for Systematic Triage of Acute Chest Pain Patients to Treatment [CT-STAT]; )