Coronary CT angiography (CTA) has the potential to cut the number of hospital admissions in individuals with acute chest pain, saving money without putting patients at risk, indicates a study presented this week at the American College of Cardiology (ACC) meeting in New Orleans.
"Our clinical study results showed that we could safely discharge low- to intermediate-risk patients with acute chest pain” from the emergency department “following a negative coronary CTA without any adverse outcome for six months after” a visit there, notes Lead Author Michael Poon, MD, professor of radiology and medicine at Stony Brook University School of Medicine, Stony Brook, N.Y. "Additionally, we are able to identify those patients with early coronary artery disease and recommend early medical intervention with the assistance of their primary care physicians.”
Coronary CTA has been demonstrated to be safe and cost-effective in the assessment of acute chest pain patients, but few studies have evaluated the technology's cost-savings potential in detail, the study’s authors write. Their research, they say, aimed to evaluate the potential reduction in admissions among patients without obstructive coronary artery disease in a busy emergency department with 90,000 visits per year.
In the course of the study, the researchers focused on those patients among 1,089 subjects who presented to the emergency department with negative initial electrocardiogram and troponin levels and who emergency department staff considered to be at low risk of coronary artery disease. An additional 4,556 patients who did not undergo coronary CTA served as a control group.
For research purposes, obstructive coronary artery disease was defined as a 50% or greater luminal diameter stenosis in any major vessel on coronary CTA. Patients with known coronary artery disease were excluded.
Among acute chest pain patients with coronary CTA who showed obstructive coronary artery disease or non-diagnostic CTA, 72 (67%) were admitted to the hospital, compared with only 89 (9%) of the normal or non-obstructive patients, the study authors wrote. Of the 4,556 acute chest pain patients in the control group who did not undergo an initial CTA test, 2,283 (50%) were admitted to the hospital, and 792 (35%) were later discharged without a specific cardiac diagnosis. Conversely, only 43 (27%) of patients who underwent initial coronary CTA were discharged without a specific cardiac diagnosis.
The authors write that coronary CTA is a cost-saving, resource-efficient imaging modality for evaluating acute chest pain and “might generate potential savings by admission avoidance” and by reducing the need for subsequent noninvasive and invasive testing. "Our data showed that coronary CTA saved more than 30% of unnecessary admissions each year compared to stress testing," Poon observes.“Without the benefit of coronary CTA, about 50% of acute chest pain patients were admitted, while the level dropped to 15% for patients who were scanned. Each unnecessary admission costs the hospital approximately $5,000. Thus for every 250 patients, the hospital saved approximately $1.3 million. We strongly believe that we have developed a robust, revolutionary, and state-of-the-art methodology for the evaluation of acute chest pain in the emergency department. It can be done seven days a week with excellent clinical outcome and is cost-effective.”