Real-world application of coronary computed tomography angiography and its potential effect on downstream resource utilization in evaluating angina
| Autor: | Patrick J. Devine, Lance E. Sullenberger, Donald R. Anderson, Allen J. Taylor, Anwar K. Malik, Irwin M. Feuerstein, Todd C. Villines |
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| Rok vydání: | 2007 |
| Předmět: |
Male
medicine.medical_specialty Cost effectiveness medicine.medical_treatment Stress testing Chest pain Coronary Angiography Angina Pectoris Resource Allocation Coronary artery disease Angina Internal medicine medicine Ambulatory Care Humans Radiology Nuclear Medicine and imaging Prospective cohort study Cardiac catheterization Retrospective Studies medicine.diagnostic_test business.industry Middle Aged medicine.disease United States Angiography Cardiology Female Radiology medicine.symptom Cardiology and Cardiovascular Medicine business Tomography X-Ray Computed |
| Zdroj: | Journal of cardiovascular computed tomography. 2(4) |
| ISSN: | 1876-861X |
| Popis: | Evaluating low-risk outpatients with chest pain is a common clinical problem and poses significant demand on clinical resource utilization. Despite the impressive performance characteristics of coronary multislice computed tomography (MSCT) angiography, its implementation in the diagnostic evaluation of outpatient chest pain and its effect on downstream resource utilization remains undefined.We compared the effect of a strategy that used MSCT with a traditional strategy (pre-MSCT strategy) in which MSCT was not available on clinical downstream resource utilization, defined as the need for further stress testing or cardiac catheterization.We retrospectively identified 75 patients without known disease who had undergone MSCT angiography for the primary indication of possible angina. The review of clinical vignettes of these 75 patients and completion of surveys assessing diagnostic strategy by two general cardiologists represented the pre-MSCT diagnostic strategy. Survey responses were compared with the number of cardiac catheterizations and stress tests that actually resulted after MSCT angiography (MSCT strategy).A strategy that used MSCT angiography in the evaluation of patients with possible angina would have significantly reduced the need for further stress testing and cardiac catheterizations (58 vs 11; P0.005). Furthermore, this strategy would have resulted in significantly fewer unnecessary cardiac catheterizations (6 vs 23; P0.005).Coronary MSCT angiography can potentially reduce the need for further stress tests or cardiac catheterizations in the evaluation of low- to intermediate-risk patients with possible angina. Prospective studies are needed to validate these findings and to assess the overall cost effectiveness of implementing MSCT early in the outpatient evaluation of angina. |
| Databáze: | OpenAIRE |
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