Abstract 13635: Downstream Test Utilization and Costs After Front-Line Diagnostic Evaluation With Coronary Computed Tomography Compared to Ischemia Testing in Patients Suspected of Angina.
Purpose: In anginal patients a high diagnostic performance of coronary computed tomography (CTA) has been demonstrated. However the clinical benefit of CTA has been questioned because CTA as compared to conventional functional tests identify more patients with atherosclerosis, hence add the risk of introducing more downstream diagnostic test utilization (DTU) and consequently increase costs. The purpose of this study was to investigate the influence of a frontline diagnostic strategy using exercise-electrocardiography (Ex-test) versus CTA on DTU and costs in “real world” practice.
Methods: In two adjacent community hospitals using either Ex-test (group A, n =247) or CTA (Dual Source technique, group B, n =251) as the front-line diagnostic tool in patients suspected of angina, cohorts of consecutive patients were retrospectively identified (Jan. 2007 – Feb. 2008). During a follow-up of 12 months DTU (coronary angiography, CA; myocardial scintigraphy, MPS; CTA), MACE (death or AMI), hospital admissions unassociated to coronary revascularization, and costs were registered.
Results: There were no differences between study cohorts in demographic characteristics or pretest risk of significant coronary artery disease (CAD). Mean (± SD) age was 56 (11) years, 52% were men, and 69% of the total study cohort was at intermediate pretest risk of significant disease. DTU was more frequent in group A as compared to group B patients, 32% versus 21% (P =0.003). Subsequent MPS was more frequent (9% versus 4%, P = 0.03), whereas CA tended to be more frequent (23% versus 18%, P =0.16) in group A as compared to group B. Costs associated with DTU and hospital admissions were 52% higher in group A than in group B (P =0.0014). The prevalence at subsequent CA (stenosis >50%) in patients with a positive index test result was lower in group A as compared to group B, 34% versus 65% (P =0.02). All MACE (n=3) occurred in patients with a negative index Ex-test result.
Conclusions: In patients suspected of angina front-line diagnostic evaluation with CTA, compared to conventional ischemia testing, incurred lower rates of DTU and lower costs.
- © 2010 by American Heart Association, Inc.