Coronary CTA triages patients with chest pain

Studies presented in the first half of 2007 added power to the argument favoring coronary CT angiography to cut some of the $10 billion spent annually to diagnose patients who arrive in the emergency room with chest pain.

Dr. Gudrun Feuchtner and colleagues at Medical University Innsbruck in Austria found coronary CTA to be a cost-effective pretest to exclude stenosis > 50% in intermediate risk patients with clinically suspected coronary artery disease. Their analysis showed the use of CTA rather than catheter angiography in 22 patients saved more than $20,000.

Dr. James A. Goldstein at William Beaumont Hospital in Michigan conducted the first prospective randomized trial demonstrating coronary CTA's value in the acute chest pain setting (J Am Coll Cardiol 2007;49:863-871). He randomized 99 patients to CTA and 98 to standard of care.

Cardiac CT either excluded or identified coronary artery disease as the cause of acute chest pain in 75% of patients, including 67 with normal coronary arteries and eight with severe disease referred for invasive evaluation. The remaining 25% required additional testing because of intermediate severity lesions or nondiagnostic scans. Diagnostic time and costs using CT were reduced to a mean 3.4 hours and $1582 versus 15 hours and $1872 for standard of care.