CHICAGO — An evaluation strategy incorporating early cardiac computed tomography angiography scans reduced the hospital length of stay and time to diagnosis for patients who presented to the ED with chest pain suggestive of acute coronary syndromes, according to results of a new study.
The Rule Out Myocardial Ischemia/Infarction Using Computer Assisted Tomography (ROMICAT II) study involved 1,000 patients at nine hospitals in the United States. Results showed that using cardiac CT angiography (CCTA) to evaluate patients with chest pain in the ED was associated with a mean length of stay of 23 hours compared with 30 hours for patients who received standard care (P=.0002). Half of the patients assigned to receive CCTA upon presentation to the ED were safely discharged within 9 hours compared with only 15% of patients assigned to receive standard care, according to results presented at the American College of Cardiology’s 61st Scientific Sessions.
The mean time to diagnosis was 10.4 hours for patients assigned to CCTA in the ED compared with 18.7 hours for patients assigned standard care (P<.0001). At 30 days, major adverse events were similar in both the CCTA and standard care groups (0.4 events vs. 1.0 events, respectively; P=.37).
In addition, the mean cost associated with early use of CCTA in the ED was $2,053 compared with $2,532 for standard care (P<.0001).
“There was no increase in costs of care despite more diagnostic testing the CCTA arm when compared with current, standard ED evaluation,” Udo Hoffmann, MD, MPH, director of imaging at Massachusetts General Hospital, said at a late-breaking clinical trial session.
Researchers enrolled patients who arrived in the ED with chest pain and who were at intermediate risk for a MI based on their symptoms and initial ED evaluation. Patients were randomly assigned to a CT scan as their first diagnostic test or standard care, which could include a cardiac stress test or no tests at all, depending on the patient’s situation and physician preference.
“This study is important because it looks at our ability to use a new technology and to address a very big problem in our health care systems. In this case, it is the large number of patients who present with chest pain to EDs,” Hoffmann said at a press conference.
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Disclosure: The study was funded by the NIH’s National Heart, Lung and Blood Institute. Dr. Hoffmann has received research grants from the NIH and Siemens Medical Systems.
You have to realize that this study was very contained. The test was only available Monday through Friday and during business hours. If you expand this to 24/7 coverage, the cost has to go up. The question is, would you save downstream? That really remains to be shown in the future.
– Michael H. Crawford, MD
Chief of Clinical Cardiology
University of California, San Francisco, Medical Center