Background: Coronary CTA has high negative predictive value in ruling out ACS and shortens the length of hospital admission in patients with acute chest pain. However, it is thought to increase the downstream testing and cost of chest pain workup. To evaluate this we compared the number of diagnostic catheterizations, duration of hospitalization and the cost of downstream evaluation between patients who performed CTA as the first test and patients who underwent stress tests (GXT) in our chest pain unit.
Methods and Results: 82 patients admitted with acute chest pain and intermediate probability for ACS were randomized to coronary CTA versus GXT. Follow up was continued up to six months. The primary endpoint was the number and cost of downstream diagnostic tests at three and six months after discharge. Secondary endpoints were number of coronary interventions and duration of hospitalization. Costs of exams were calculated according to the official ministry of health tariff.
Mean duration of hospitalization was 2.1±1.3 in the CTA arm and 2.2 ±1.7 in the GXT arm (p=0.87). At three months mean number of ambulatory tests per patient was 0.24±0.62 in the CT arm and 0.43±0.71 in the GXT arm (p=0.21), and at six months it was 0.22±0.42 and 0.57±0.82 (p=0.05) accordingly. The cost of these exams was 332±1,044NIS in the CT arm versus 708±1,532NIS in the GXT arm (p=0.2) and at six months 239±755NIS versus 580±1,201NIS (p=0.2) accordingly. 6 patients in the CTA arm underwent invasive coronary angiography, of which four had coronary interventions, while 4 patients in the GXT group had invasive coronary angiography, and one of them had coronary intervention.
Conclusions: Evaluation of acute chest pain with coronary CTA does not prolong the duration of hospitalization, causes less downstream testing at six months after discharge, and was not found to be more expensive than evaluation with GXT.
