Journal of Cardiovascular Computed Tomography
Volume 2, Issue 4 , Pages 214-219, July 2008

Real-world application of coronary computed tomography angiography and its potential effect on downstream resource utilization in evaluating angina

  • Patrick J. Devine, MD

      Affiliations

    • Cardiology Service, Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Building 2, Room 4A-05, Washington, DC, 20307-5001 USA
    • ,
  • Todd C. Villines, MD

      Affiliations

    • Cardiology Service, Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Building 2, Room 4A-05, Washington, DC, 20307-5001 USA
    • Corresponding Author InformationCorresponding author.
    • ,
  • Lance E. Sullenberger, MD

      Affiliations

    • Cardiology Service, Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Building 2, Room 4A-05, Washington, DC, 20307-5001 USA
    • ,
  • Donald R. Anderson, MD

      Affiliations

    • Cardiology Service, Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Building 2, Room 4A-05, Washington, DC, 20307-5001 USA
    • ,
  • Anwar K. Malik, MD

      Affiliations

    • Cardiology Service, Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Building 2, Room 4A-05, Washington, DC, 20307-5001 USA
    • ,
  • Irwin M. Feuerstein, MD

      Affiliations

    • Department of Radiology, Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Building 2, Room 4A-05, Washington, DC, 20307-5001 USA
    • ,
  • Allen J. Taylor, MD

      Affiliations

    • Cardiology Service, Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Building 2, Room 4A-05, Washington, DC, 20307-5001 USA

Received 18 December 2007; accepted 16 May 2008. published online 23 May 2008.

Background

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.

Objective

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.

Methods

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).

Results

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; P < 0.005). Furthermore, this strategy would have resulted in significantly fewer unnecessary cardiac catheterizations (6 vs 23; P < 0.005).

Conclusions

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.

Keywords: Angina, Cardiac computed tomography, Chest pain, Coronary artery disease, Resource utilization

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 Conflict of interest: The authors report no conflicts of interest.The opinions or assertions herein are the private views of the authors and are not to be construed as reflecting the views of the Department of the Army or the Department of Defense.

PII: S1934-5925(08)00172-X

doi:10.1016/j.jcct.2008.05.002

Journal of Cardiovascular Computed Tomography
Volume 2, Issue 4 , Pages 214-219, July 2008

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