Comparative Trends and Downstream Outcomes of Coronary Computed Tomography Angiography and Cardiac Stress Testing in Emergency Department Patients With Chest Pain: An Administrative Claims Analysis

Autor: Deepi G. Goyal, M. Fernanda Bellolio, Stephanie R. Schilz, Nilay Shah, Malcolm R. Bell, Lindsey R. Sangaralingham, Waqas I Gilani, Stephen L. Kopecky, Jacob R. Morris, Erik P. Hess
Rok vydání: 2016
Předmět:
Adult
Male
Chest Pain
medicine.medical_specialty
Adolescent
Computed Tomography Angiography
medicine.medical_treatment
Stress testing
Myocardial Infarction
030204 cardiovascular system & hematology
Coronary Angiography
Chest pain
Coronary artery disease
Insurance Claim Review
Young Adult
03 medical and health sciences
Percutaneous Coronary Intervention
0302 clinical medicine
Internal medicine
medicine
Humans
030212 general & internal medicine
Myocardial infarction
Propensity Score
Aged
medicine.diagnostic_test
business.industry
Percutaneous coronary intervention
Cardiac stress test
General Medicine
Middle Aged
medicine.disease
United States
Hospitalization
Logistic Models
Conventional PCI
Exercise Test
Emergency Medicine
Cardiology
Female
Myocardial infarction diagnosis
medicine.symptom
Emergency Service
Hospital
business
Zdroj: Academic Emergency Medicine. 23:1022-1030
ISSN: 1069-6563
DOI: 10.1111/acem.13005
Popis: OBJECTIVES Coronary computerized tomography angiography (CCTA) is a rapidly emerging technology for the evaluation of chest pain in the emergency department (ED). We assessed trends in CCTA use and compared downstream healthcare utilization between CCTA and cardiac stress testing modalities. METHODS Using administrative claims data (Optum Labs Data Warehouse) from over 100 million geographically diverse privately insured and Medicare Advantage enrollees across the United States, we identified 2,047,799 ED patients from January 2006 to December 2013 who presented with chest pain and had a CCTA or cardiac stress test within 72 hours. Cohorts were established based on CCTA or functional stress testing (myocardial perfusion scintigraphy [MPS], stress echocardiogram [SE], or treadmill exercise electrocardiogram [TMET]) performed within 72 hours of the ED visit. We tracked subsequent invasive cardiac procedures (invasive coronary angiography [ICA], percutaneous coronary intervention [PCI], and coronary artery bypass grafting [CABG]), repeat noninvasive testing, return ED visits, hospitalization, and the rate of acute myocardial infarction (AMI) within 30 days. We used propensity-score matching to adjust for coronary artery disease (CAD) risk factors, Charlson-Deyo comorbidity index, and baseline differences between patients selected for CCTA or cardiac stress testing. Logistic regression was used to measure adjusted associations between testing modality and outcomes. RESULTS During the study period, CCTA use increased from 0.8% to 4.5% of all cardiac testing within 72 hours, a change of 434% (p-value for trend < 0.001), while rates of other cardiac stress testing modalities decreased (-22% for TMET [p < 0.001]; -11% for SE [p = 0.11]; -6% for MPS [p = 0.04]. After matching, there was no difference in the 30-day rate of AMI between testing modalities. Compared to MPS, CCTA was associated with higher rates of PCI (odds ratio [OR] = 1.25, 95% confidence interval [CI] = 1.04 to 1.51), and CABG (OR = 1.47; 95% CI = 1.03 to 2.13). Compared to SE and treadmill stress testing, CCTA was associated with more invasive procedures, hospitalizations, return ED visits, and repeat noninvasive testing. CONCLUSIONS CCTA use increased fourfold during the study period and was associated with higher rates of PCI, CABG, repeat noninvasive testing, hospitalization, and return ED visits. The authors have no relevant financial information or potential conflicts to disclose.
Databáze: OpenAIRE
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