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Comparative effectiveness of coronary CT angiography vs stress cardiac imaging in patients following hospital admission for chest pain work-up: The Prospective First Evaluation in Chest Pain (PERFECT) Trial

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Because the frequency of cardiac event rates is low among chest pain patients following either performance of coronary CT angiography (CCTA) or stress testing, there is a need to better assess how these tests influence the central management decisions that follow from cardiac testing. The present study was performed to assess the relative impact of CCTA vs stress testing on medical therapies and downstream resource utilization among patients admitted for the work-up of chest pain.

Methods

The admitted patients were randomized in a 1:1 ratio to either cardiac imaging stress test or CCTA. Primary outcomes were time to discharge, change in medication usage, and frequency of downstream testing, cardiac interventions, and cardiovascular re-hospitalizations. We randomized 411 patients, 205 to stress testing, and 206 to CCTA.

Results

There were no differences in time to discharge or initiation of new cardiac medications at discharge. At 1 year follow-up, there was no difference in the number of patients who underwent cardiovascular downstream tests in the CCTA vs stress test patients (21% vs 15%, P = .1) or cardiovascular hospitalizations (14% vs 16%, P = .5). However, there was a higher frequency of invasive angiography in the CCTA group (11% vs 2%, P = .001) and percutaneous coronary interventions (6% vs 0%, P < .001).

Conclusions

Randomization of hospitalized patients admitted for chest pain work-up to either CCTA or to stress testing resulted in similar discharge times, change in medical therapies at discharge, frequency of downstream noninvasive testing, and repeat hospitalizations. However, a higher frequency of invasive coronary angiography and revascularization procedures were performed in the CCTA arm. (ClinicalTrials.gov number, NCT01604655.)

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Abbreviations

CAC:

Coronary artery calcium

CAD:

Coronary artery calcium score

CCTA:

Coronary computed tomography angiography

ECG:

Electrocardiogram

MPI:

Myocardial perfusion imaging

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Acknowledgments

The authors thank Jhenielle Reynolds for her excellent support in data collection.

Conflicts of interest

The authors have no conflicts of interest to declare.

Author information

Authors and Affiliations

  1. Department of Cardiovascular Medicine, Morristown Medical Center, Gagnon Cardiovascular Institute, 100 Madison Ave, Morristown, NJ, 07960, USA

    Seth Uretsky MD, FACC

  2. Division of Cardiology, Department of Medicine, Mount Sinai St. Luke’s Hospital, New York, NY, USA

    Edgar Argulian MD, MPH, Georges El-Hayek MD, Patricia Chavez MD, Hira Awan MD, Ashadevi Jagarlamudi MD, Siva P. Puppala MD, Randy Cohen MD & Alan Rozanski MD

  3. Northshore LIJ Southside Hospital, Hofstra School of Medicine, NSLIJHS, Bayshore, NY, USA

    Azhar Supariwala MD

  4. Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Shiv K. Agarwal MD

Authors
  1. Seth Uretsky MD, FACC
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  2. Edgar Argulian MD, MPH
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  3. Azhar Supariwala MD
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  4. Shiv K. Agarwal MD
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  5. Georges El-Hayek MD
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  6. Patricia Chavez MD
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  8. Ashadevi Jagarlamudi MD
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  9. Siva P. Puppala MD
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  10. Randy Cohen MD
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  11. Alan Rozanski MD
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Corresponding author

Correspondence to Seth Uretsky MD, FACC.

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See related editorial, doi:10.1007/s12350-016-0494-3.

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Uretsky, S., Argulian, E., Supariwala, A. et al. Comparative effectiveness of coronary CT angiography vs stress cardiac imaging in patients following hospital admission for chest pain work-up: The Prospective First Evaluation in Chest Pain (PERFECT) Trial. J. Nucl. Cardiol. 24, 1267–1278 (2017). https://doi.org/10.1007/s12350-015-0354-6

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  • DOI: https://doi.org/10.1007/s12350-015-0354-6

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