Coronary Computed Tomography Angiography Versus Stress Echocardiography in Acute Chest Pain: A Randomized Controlled Trial

Jeffrey M. Levsky, Linda B. Haramati, Daniel M. Spevack, Mark A. Menegus, Terence Chen, Sarah Mizrachi, Durline Brown-Manhertz, Samantha Selesny, Rikah Lerer, Deborah J. White, Jonathan N. Tobin, Cynthia C. Taub, Mario J. Garcia

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objectives: This study sought to compare early emergency department (ED) use of coronary computed tomography angiography (CTA) and stress echocardiography (SE) head-to-head. Background: Coronary CTA has been promoted as the early ED chest pain triage imaging method of choice, whereas SE is often overlooked in this setting and involves no ionizing radiation. Methods: The authors randomized 400 consecutive low- to intermediate-risk ED acute chest pain patients without known coronary artery disease and a negative initial serum troponin level to immediate coronary CTA (n = 201) or SE (n = 199). The primary endpoint was hospitalization rate. Secondary endpoints were ED and hospital length of stay. Safety endpoints included cardiovascular events and radiation exposure. Results: Mean patient age was 55 years, with 43% women and predominantly ethnic minorities (46% Hispanics, 32% African Americans). Thirty-nine coronary CTA patients (19%) and 22 SE patients (11%) were hospitalized at presentation (difference 8%; 95% confidence interval: 1% to 15%; p = 0.026). Median ED length of stay for discharged patients was 5.4 h (interquartile range [IQR]: 4.2 to 6.4 h) for coronary CTA and 4.7 h (IQR: 3.5 to 6.0 h) for SE (p < 0.001). Median hospital length of stay was 58 h (IQR: 50 to 102 h) for coronary CTA and 34 h (IQR: 31 to 54 h) for SE (p = 0.002). There were 11 and 7 major adverse cardiovascular events for coronary CTA and SE, respectively (p = 0.47), over a median 24 months of follow-up. Median/mean complete initial work-up radiation exposure was 6.5/7.7 mSv for coronary CTA and 0/0.96 mSv for SE (p < 0.001). Conclusions: The use of SE resulted in the hospitalization of a smaller proportion of patients with a shorter length of stay than coronary CTA and was safe. SE should be considered an appropriate option for ED chest pain triage (Stress Echocardiography and Heart Computed Tomography [CT] Scan in Emergency Department Patients With Chest Pain; NCT01384448).

Original languageEnglish (US)
JournalJACC: Cardiovascular Imaging
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Stress Echocardiography
Acute Pain
Chest Pain
Randomized Controlled Trials
Hospital Emergency Service
Length of Stay
Triage
Hospitalization
Computed Tomography Angiography
Troponin
Ionizing Radiation
Hispanic Americans
African Americans
Coronary Artery Disease
Tomography

Keywords

  • acute chest pain
  • admission rate
  • coronary CT angiography
  • emergency department
  • length of stay
  • stress echocardiography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Coronary Computed Tomography Angiography Versus Stress Echocardiography in Acute Chest Pain : A Randomized Controlled Trial. / Levsky, Jeffrey M.; Haramati, Linda B.; Spevack, Daniel M.; Menegus, Mark A.; Chen, Terence; Mizrachi, Sarah; Brown-Manhertz, Durline; Selesny, Samantha; Lerer, Rikah; White, Deborah J.; Tobin, Jonathan N.; Taub, Cynthia C.; Garcia, Mario J.

In: JACC: Cardiovascular Imaging, 01.01.2018.

Research output: Contribution to journalArticle

Levsky, Jeffrey M. ; Haramati, Linda B. ; Spevack, Daniel M. ; Menegus, Mark A. ; Chen, Terence ; Mizrachi, Sarah ; Brown-Manhertz, Durline ; Selesny, Samantha ; Lerer, Rikah ; White, Deborah J. ; Tobin, Jonathan N. ; Taub, Cynthia C. ; Garcia, Mario J. / Coronary Computed Tomography Angiography Versus Stress Echocardiography in Acute Chest Pain : A Randomized Controlled Trial. In: JACC: Cardiovascular Imaging. 2018.
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abstract = "Objectives: This study sought to compare early emergency department (ED) use of coronary computed tomography angiography (CTA) and stress echocardiography (SE) head-to-head. Background: Coronary CTA has been promoted as the early ED chest pain triage imaging method of choice, whereas SE is often overlooked in this setting and involves no ionizing radiation. Methods: The authors randomized 400 consecutive low- to intermediate-risk ED acute chest pain patients without known coronary artery disease and a negative initial serum troponin level to immediate coronary CTA (n = 201) or SE (n = 199). The primary endpoint was hospitalization rate. Secondary endpoints were ED and hospital length of stay. Safety endpoints included cardiovascular events and radiation exposure. Results: Mean patient age was 55 years, with 43{\%} women and predominantly ethnic minorities (46{\%} Hispanics, 32{\%} African Americans). Thirty-nine coronary CTA patients (19{\%}) and 22 SE patients (11{\%}) were hospitalized at presentation (difference 8{\%}; 95{\%} confidence interval: 1{\%} to 15{\%}; p = 0.026). Median ED length of stay for discharged patients was 5.4 h (interquartile range [IQR]: 4.2 to 6.4 h) for coronary CTA and 4.7 h (IQR: 3.5 to 6.0 h) for SE (p < 0.001). Median hospital length of stay was 58 h (IQR: 50 to 102 h) for coronary CTA and 34 h (IQR: 31 to 54 h) for SE (p = 0.002). There were 11 and 7 major adverse cardiovascular events for coronary CTA and SE, respectively (p = 0.47), over a median 24 months of follow-up. Median/mean complete initial work-up radiation exposure was 6.5/7.7 mSv for coronary CTA and 0/0.96 mSv for SE (p < 0.001). Conclusions: The use of SE resulted in the hospitalization of a smaller proportion of patients with a shorter length of stay than coronary CTA and was safe. SE should be considered an appropriate option for ED chest pain triage (Stress Echocardiography and Heart Computed Tomography [CT] Scan in Emergency Department Patients With Chest Pain; NCT01384448).",
keywords = "acute chest pain, admission rate, coronary CT angiography, emergency department, length of stay, stress echocardiography",
author = "Levsky, {Jeffrey M.} and Haramati, {Linda B.} and Spevack, {Daniel M.} and Menegus, {Mark A.} and Terence Chen and Sarah Mizrachi and Durline Brown-Manhertz and Samantha Selesny and Rikah Lerer and White, {Deborah J.} and Tobin, {Jonathan N.} and Taub, {Cynthia C.} and Garcia, {Mario J.}",
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T1 - Coronary Computed Tomography Angiography Versus Stress Echocardiography in Acute Chest Pain

T2 - A Randomized Controlled Trial

AU - Levsky, Jeffrey M.

AU - Haramati, Linda B.

AU - Spevack, Daniel M.

AU - Menegus, Mark A.

AU - Chen, Terence

AU - Mizrachi, Sarah

AU - Brown-Manhertz, Durline

AU - Selesny, Samantha

AU - Lerer, Rikah

AU - White, Deborah J.

AU - Tobin, Jonathan N.

AU - Taub, Cynthia C.

AU - Garcia, Mario J.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objectives: This study sought to compare early emergency department (ED) use of coronary computed tomography angiography (CTA) and stress echocardiography (SE) head-to-head. Background: Coronary CTA has been promoted as the early ED chest pain triage imaging method of choice, whereas SE is often overlooked in this setting and involves no ionizing radiation. Methods: The authors randomized 400 consecutive low- to intermediate-risk ED acute chest pain patients without known coronary artery disease and a negative initial serum troponin level to immediate coronary CTA (n = 201) or SE (n = 199). The primary endpoint was hospitalization rate. Secondary endpoints were ED and hospital length of stay. Safety endpoints included cardiovascular events and radiation exposure. Results: Mean patient age was 55 years, with 43% women and predominantly ethnic minorities (46% Hispanics, 32% African Americans). Thirty-nine coronary CTA patients (19%) and 22 SE patients (11%) were hospitalized at presentation (difference 8%; 95% confidence interval: 1% to 15%; p = 0.026). Median ED length of stay for discharged patients was 5.4 h (interquartile range [IQR]: 4.2 to 6.4 h) for coronary CTA and 4.7 h (IQR: 3.5 to 6.0 h) for SE (p < 0.001). Median hospital length of stay was 58 h (IQR: 50 to 102 h) for coronary CTA and 34 h (IQR: 31 to 54 h) for SE (p = 0.002). There were 11 and 7 major adverse cardiovascular events for coronary CTA and SE, respectively (p = 0.47), over a median 24 months of follow-up. Median/mean complete initial work-up radiation exposure was 6.5/7.7 mSv for coronary CTA and 0/0.96 mSv for SE (p < 0.001). Conclusions: The use of SE resulted in the hospitalization of a smaller proportion of patients with a shorter length of stay than coronary CTA and was safe. SE should be considered an appropriate option for ED chest pain triage (Stress Echocardiography and Heart Computed Tomography [CT] Scan in Emergency Department Patients With Chest Pain; NCT01384448).

AB - Objectives: This study sought to compare early emergency department (ED) use of coronary computed tomography angiography (CTA) and stress echocardiography (SE) head-to-head. Background: Coronary CTA has been promoted as the early ED chest pain triage imaging method of choice, whereas SE is often overlooked in this setting and involves no ionizing radiation. Methods: The authors randomized 400 consecutive low- to intermediate-risk ED acute chest pain patients without known coronary artery disease and a negative initial serum troponin level to immediate coronary CTA (n = 201) or SE (n = 199). The primary endpoint was hospitalization rate. Secondary endpoints were ED and hospital length of stay. Safety endpoints included cardiovascular events and radiation exposure. Results: Mean patient age was 55 years, with 43% women and predominantly ethnic minorities (46% Hispanics, 32% African Americans). Thirty-nine coronary CTA patients (19%) and 22 SE patients (11%) were hospitalized at presentation (difference 8%; 95% confidence interval: 1% to 15%; p = 0.026). Median ED length of stay for discharged patients was 5.4 h (interquartile range [IQR]: 4.2 to 6.4 h) for coronary CTA and 4.7 h (IQR: 3.5 to 6.0 h) for SE (p < 0.001). Median hospital length of stay was 58 h (IQR: 50 to 102 h) for coronary CTA and 34 h (IQR: 31 to 54 h) for SE (p = 0.002). There were 11 and 7 major adverse cardiovascular events for coronary CTA and SE, respectively (p = 0.47), over a median 24 months of follow-up. Median/mean complete initial work-up radiation exposure was 6.5/7.7 mSv for coronary CTA and 0/0.96 mSv for SE (p < 0.001). Conclusions: The use of SE resulted in the hospitalization of a smaller proportion of patients with a shorter length of stay than coronary CTA and was safe. SE should be considered an appropriate option for ED chest pain triage (Stress Echocardiography and Heart Computed Tomography [CT] Scan in Emergency Department Patients With Chest Pain; NCT01384448).

KW - acute chest pain

KW - admission rate

KW - coronary CT angiography

KW - emergency department

KW - length of stay

KW - stress echocardiography

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