Association of Coronary CT Angiography or Stress Testing With Subsequent Utilization and Spending Among Medicare Beneficiaries
Association of Coronary CT Angiography or Stress Testing With Subsequent Utilization and Spending Among Medicare Beneficiaries
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DOI：
10.1001/jama.2011.1652
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发表时间：
2011-11-16
影响因子：
120.7
通讯作者：
Hlatky, Mark A.
中科院分区：
文献类型：
--
作者：
Shreibati, Jacqueline Baras;Baker, Laurence C.;Hlatky, Mark A.
冠状动脉计算机断层扫描血管造影术（CCTA）是一种新的无创性冠状动脉疾病（CAD）诊断检查，但其与后续临床管理的关系尚未建立。（压力测试）和解剖学（CCTA）无创心脏测试在医疗保险人群中的应用。设计、设置和患者回顾性研究，一项观察性队列研究，使用2005-2008年66岁或以上的医疗保险按服务收费受益人的20%随机样本的索赔数据，这些受益人在前一年未因CAD索赔，接受了非紧急、非侵入性CAD检测（n= 282830）.主要结果指标心导管插入术、冠状动脉血运重建术、急性心肌梗死、全因死亡率以及随访180天内的总医疗费用和CAD相关医疗费用。CCTA与随后心导管插入术的可能性增加相关（22.9% vs 12.1%;校正比值比[AOR]，2.19 [95%CI，2.08 - 2.32]; P
Context Coronary computed tomography angiography (CCTA) is a new noninvasive diagnostic test for coronary artery disease (CAD), but its association with subsequent clinical management has not been established.Objective To compare utilization and spending associated with functional (stress testing) and anatomical (CCTA) noninvasive cardiac testing in a Medicare population.Design, Setting, and Patients Retrospective, observational cohort study using claims data from a 20% random sample of 2005-2008 Medicare fee-for-service beneficiaries 66 years or older with no claims for CAD in the preceding year, who received nonemergent, noninvasive testing for CAD (n=282 830).Main Outcome Measures Cardiac catheterization, coronary revascularization, acute myocardial infarction, all-cause mortality, and total and CAD-related Medicare spending over 180 days of follow-up.Results Compared with stress myocardial perfusion scintigraphy (MPS), CCTA was associated with an increased likelihood of subsequent cardiac catheterization (22.9% vs 12.1%; adjusted odds ratio [AOR], 2.19 [95% CI, 2.08 to 2.32]; P