August 25, 2023 — Coronary CT angiography (CCTA) is a safe and cost-effective way to rule out acute coronary syndrome in patients experiencing acute chest pain, according to a research review published August 24 in Radiology: Cardiothoracic Imaging.
The findings are good news for both clinicians and patients, wrote a team led by Mauricio Barbosa, MD, of Southwestern Medical Center at Dallas.
“[Our review] reassures health care decision-makers that CCTA is a safe strategy to rule out acute coronary syndrome in adult patients presenting with acute chest pain as pooled evidence shows similar incidence of myocardial infarction … and mortality … between CCTA and standard of care arms,” the group said.
Acute chest pain is the second most common condition for which patients present to the emergency department, the group noted. Some of these patients will in fact have acute coronary syndrome, but most do not, making it important to have an effective way to rule out disease. The standard of care in this regard includes observation, electrocardiography, and stress testing — all of which take significant time and raise healthcare costs.
CCTA may offer key benefits compared to the standard of care methods. Barbosa and colleagues conducted a literature review to assess CCTA’s efficacy, including 22 randomized controlled trials reported in studies from Cochrane Library, Embase, Google Scholar, Science Direct, Scopus, PubMed, and Web of Science. The studies represented 9,379 total participants, 4,956 of which were assigned to CCTA research arms and 4,423 to the standard of care arms. Barbosa’s group categorized the studies into two groups by probability for acute coronary syndrome (group 1, low-to-intermediate risk and group 2, high risk).
The team found that using CCTA to rule out acute coronary syndrome showed an overall reduction in length of stay in the emergency department by 14% and in immediate costs by 17% compared with using standard-of-care protocols. Among low- to intermediate-risk patients, CCTA reduced length of stay by 17% and costs by 21%.
There were no differences between the two arms in referrals to invasive coronary angiography, incidence of myocardial infarction, mortality, rate of hospitalization, further stress testing, or readmissions, the investigators reported.
“Our results support the current guidelines’ recommendations for the use of CCTA as a safe, rapid, and less expensive in the short-term strategy to exclude acute coronary syndrome in low- to intermediate-risk patients presenting with acute chest pain,” they concluded.
The complete study can be found here.