Diagnostic performance and cost of CT angiography versus stress ECG - A randomized prospective study of suspected acute coronary syndrome chest pain in the emergency department (CT-COMPARE)
Diagnostic performance and cost of CT angiography versus stress ECG - A randomized prospective study of suspected acute coronary syndrome chest pain in the emergency department (CT-COMPARE)
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DOI：
10.1016/j.ijcard.2014.10.090
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发表时间：
2014-12-20
影响因子：
3.5
通讯作者：
Branch, Kelley R.
中科院分区：
文献类型：
--
作者：
Hamilton-Craig, Christian;Fifoot, Allison;Branch, Kelley R.
背景：冠状动脉CT血管造影术（CCTA）具有高灵敏度，最近3项随机试验将CCTA与标准治疗进行了有利的比较。比较运动负荷心电图（ExECG），最可用的和最便宜的标准的护理世界各地，还没有系统tested.Methods：CT比较是一项随机，单中心试验的低中度风险胸痛受试者进行CCTA或ExECG后，第一个负肌钙蛋白。从2010年3月至2011年4月，562例患者被随机分配至双源CCTA（n = 322）或ExECG（n = 240）。主要终点是ACS的诊断性能和30天的住院费用。次要终点是出院时间、住院率和下游资源利用率。结果：24例（4%）患者发生ACS。ExECG对ACS有213项阴性研究和27项（26%）阳性研究，灵敏度为83% [95% CI：36，99.6%]，特异性为91% [CI：86，94%]，ROC AUC为0.87 [CI：0.70，1]。CCTA（狭窄>50%视为阳性）有288项阴性研究和18/35（51%）项阳性研究，灵敏度为100% [CI：81.5，100]，特异性为94% [CI：91.2，96.7%]，ROC为0.97 [CI：0.92，1.0; p = 0.2]。尽管CCTA的下游检测几率较高（OR 2.0），但CCTA的30天每例患者成本显著较低（2193美元vs 2704美元，p < 0.001）。CCTA的住院时间显著缩短（13.5 h [95% CI：11.2-15.7]，ExECG 19.7 h [95% CI：17.4-22.1]，p < 0.0005），这促使成本降低。出院30天后，没有患者发生心血管事件。结论：与ExECG相比，CCTA提高了诊断性能，住院时间相对缩短了35%，住院费用减少了20%。这些数据进一步证明CCTA作为急诊科胸痛的一线评估是有用的。(C)2014作者出版社：Elsevier爱尔兰Ltd.
Background: Coronary CT angiography (CCTA) has high sensitivity, with 3 recent randomized trials favorably comparing CCTA to standard-of-care. Comparison to exercise stress ECG (ExECG), the most available and least expensive standard-of-care worldwide, has not been systematically tested.Methods: CT-COMPARE was a randomized, single-center trial of low-intermediate risk chest pain subjects undergoing CCTA or ExECG after the first negative troponin. From March 2010 to April 2011, 562 patients randomized to either dual-source CCTA (n = 322) or ExECG (n = 240). Primary endpoints were diagnostic performance for ACS, and hospital cost at 30 days. Secondary endpoints were time-to-discharge, admission rates, and downstream resource utilization.Results: ACS occurred in 24 (4%) patients. ExECG had 213 negative studies and 27 (26%) positive studies for ACS with sensitivity of 83% [95% CI: 36, 99.6%], specificity of 91% [CI: 86, 94%], and ROC AUC of 0.87 [CI: 0.70, 1]. CCTA (>50% stenosis considered positive) had 288 negative studies and 18/35 (51%) positive studies with a sensitivity of 100% [CI: 81.5, 100], specificity of 94% [CI: 91.2, 96.7%], and ROC of 0.97 [CI: 0.92, 1.0; p = 0.2]. Despite CCTA having higher odds of downstream testing (OR 2.0), 30 day per-patient cost was significantly lower for CCTA ($2193 vs $2704, p < 0.001). Length of stay for CCTA was significantly reduced (13.5 h [95% CI: 11.2-15.7], ExECG 19.7 h [95% CI: 17.4-22.1], p < 0.0005), which drove the reduction in cost. No patient had post-discharge cardiovascular events at 30 days.Conclusions: CCTA had improved diagnostic performance compared to ExECG, combined with 35% relative reduction in length-of-stay, and 20% reduction in hospital costs. These data lend further evidence that CCTA is useful as a first line assessment in emergency department chest pain. (C) 2014 The Authors. Published by Elsevier Ireland Ltd.