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Age- and sex-based resource utilisation and costs in patients with acute chest pain undergoing cardiac CT angiography: pooled evidence from ROMICAT II and ACRIN-PA trials

  • Cardiac
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To determine resource utilisation according to age and gender-specific subgroups in two large randomized diagnostic trials.

Methods

We pooled patient-specific data from ACRIN-PA 4005 and ROMICAT II that enrolled subjects with acute chest pain at 14 US sites. Subjects were randomized between a standard work-up and a pathway utilizing cardiac computed tomography angiography (CCTA) and followed for the occurrence of acute coronary syndrome (ACS) and resource utilisation during index hospitalisation and 1-month follow-up. Study endpoints included diagnostic accuracy of CCTA for the detection of ACS as well as resource utilisation.

Results

Among 1240 patients who underwent CCTA, negative predictive value of CCTA to rule out ACS remained very high (≥99.4%). The proportion of patients undergoing additional diagnostic testing and cost increased with age for both sexes (p < 0.001), and was higher in men as compared to women older than 60 years (43.1% vs. 23.4% and $4559 ± 3382 vs. $3179 ± 2562, p < 0.01; respectively). Cost to rule out ACS was higher in men (p < 0.001) and significantly higher for patients older than 60 years ($2860–5935 in men, p < 0.001).

Conclusions

CCTA strategy in patients with acute chest pain results in varying resource utilisation according to age and gender-specific subgroups, mandating improved selection for advanced imaging.

Key Points

• In this analysis, CAD and ACS increased with age and male gender.

• CCTA in patients with acute chest pain results in varying resource utilisation.

• Significant increase of diagnostic testing and cost with age for both sexes.

• Cost to rule out ACS is higher in men and patients >60 years.

• Improved selection of subjects for cardiac CTA result in more resource-driven implementation.

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Abbreviations

ACS:

Acute coronary syndrome

CABG:

Coronary artery bypass graft

CAD:

Coronary artery disease

CCTA:

Cardiac computed tomography angiography

CT:

Computed tomography

CTA:

Computed tomography angiography

ECG:

Electrocardiogram

ED:

Emergency department

NPV:

Negative predictive value

PCI:

Percutaneous coronary intervention

PPV:

Positive predictive value

SD:

Standard deviation

SOC:

Standard of care

TIMI:

Thrombolysis in myocardial infarction

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Author information

Authors and Affiliations

  1. Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Fabian Bamberg, Thomas Mayrhofer, Maros Ferencik, Daniel O. Bittner, Travis R. Hallett, Sumbal Janjua, Christopher L. Schlett & Udo Hoffmann

  2. Department of Diagnostic and Interventional Radiology, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany

    Fabian Bamberg & Udo Hoffmann

  3. Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Thomas Mayrhofer, Daniel O. Bittner, Travis R. Hallett & Sumbal Janjua

  4. School of Business Studies, Stralsund University of Applied Science, Stralsund, Germany

    Thomas Mayrhofer

  5. Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA

    Maros Ferencik

  6. Department of Medicine 2 - Cardiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany

    Daniel O. Bittner

  7. Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    John T. Nagurney

  8. Division of Cardiology and the Cardio-Vascular Center, Tufts Medical Center, Boston, MA, USA

    James E. Udelson

  9. Weill Cornell Medical College, New York, NY, USA

    Quynh A. Truong

  10. Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA

    Pamela K. Woodard

  11. Department of Emergency Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA

    Judd E. Hollander

  12. Department of Radiology and Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Harold Litt

Authors
  1. Fabian Bamberg
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  2. Thomas Mayrhofer
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  3. Maros Ferencik
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  4. Daniel O. Bittner
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  5. Travis R. Hallett
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  6. Sumbal Janjua
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  7. Christopher L. Schlett
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  8. John T. Nagurney
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  9. James E. Udelson
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  10. Quynh A. Truong
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  11. Pamela K. Woodard
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  12. Judd E. Hollander
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  13. Harold Litt
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  14. Udo Hoffmann
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Corresponding author

Correspondence to Fabian Bamberg.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Udo Hoffmann, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Funding

This study has received funding by:

ACRIN PA 4005 Funding: NIH, Supported by the Commonwealth of Pennsylvania Department of Health (SAP4100042725) and the American College of Radiology Imaging Network Foundation/ACR Imaging Core Lab.

ROMICAT II Funding: National Heart, Lung, and Blood Institute (U01HL092040 and U01HL092022) and the National Institutes of Health (UL1RR025758, K23HL098370, and L30HL093896, to Dr. Truong)

Additional Funding: K24HL113128 for Drs. Mayrhofer, Ferencik, Bittner, and Mr. Hallett; T32HL076136 for Dr. Janjua.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously published (Litt et al, NEJM 2012 and Hoffmann et al., NEJM 2012).

Methodology

• prospective

• randomised controlled trial

• multicentre study

Electronic supplementary material

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Supplementary Table 1

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Bamberg, F., Mayrhofer, T., Ferencik, M. et al. Age- and sex-based resource utilisation and costs in patients with acute chest pain undergoing cardiac CT angiography: pooled evidence from ROMICAT II and ACRIN-PA trials. Eur Radiol 28, 851–860 (2018). https://doi.org/10.1007/s00330-017-4981-y

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  • DOI: https://doi.org/10.1007/s00330-017-4981-y

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