CT Imaging Better Than Stress Testing in Chest Pain Diagnosis

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A multi-center trial initiated and coordinated at Beaumont Health System shows that computed tomography heart imaging is accurate, faster and less costly than nuclear cardiology stress testing when diagnosing low-risk chest pain patients in the Emergency Center. The research is published in the Sept. 26 issue of the Journal of the American College of Cardiology.

A multi-center trial initiated and coordinated at Beaumont Health System shows that computed tomography heart imaging is accurate, faster and less costly than nuclear cardiology stress testing when diagnosing low-risk chest pain patients in the Emergency Center.

The research is published in the Sept. 26 issue of the Journal of the American College of Cardiology.

Each year, about eight million patients in the U.S. seek emergency treatment for chest pain. While most with obvious heart attacks can be diagnosed easily and quickly with EKGs, those identified as "low risk" require more extensive testing to diagnose or rule out a heart attack.

Emergency departments typically rely on a patient history, a series of EKGs and biomarker blood testing to diagnose "low risk" patients. This approach has resulted in the discharge of 2 percent of patients who were later diagnosed with acute heart attack who have a higher mortality rate as a result.

To avoid this problem, many Emergency departments now use "rule out" protocols for low-risk patients that include cardiac stress testing and/or CT heart imaging. While more accurate, this is time consuming and expensive – with costs estimated at $10 to $12 billion annually in the U.S. alone.

In the Beaumont study, lead investigators Gilbert Raff, M.D, director, Ministrelli Center for Advanced Cardiovascular Imaging, and James Goldstein, M.D., director, cardiology research and education, looked at the accuracy and speed of cardiac CT versus nuclear stress testing for low-risk chest pain evaluation.

"At a time when economic resources are constrained, while health care demand is increasing, it is important to compare the effectiveness of diagnostic methods not only for safety and accuracy, but for efficiency and cost," says Dr. Goldstein, professor of medicine with the Oakland University William Beaumont School of Medicine. "Consumers and insurers want high-value care that’s high quality at an affordable cost."

The study, called CT-STAT (Coronary Computed Tomographic Angiography for Systematic Triage of Acute Chest Pain) found that use of CT imaging for low-risk chest pain diagnosis was more rapid and less costly than rest-stress testing.

"CT angiography was 54 percent faster in diagnosis and 38 percent less expensive in terms of overall cost of emergency care with no difference in adverse cardiac events," says Dr. Raff. "The median cost of CT imaging was $2,137 versus $3,458 for stress testing."

The study, conducted June 2007 – November 2008, involved 749 patients at 11 university and five community-based hospital emergency rooms in eight states. It was supported by a grant from Bayer HealthCare, Berlin, Germany.

"This research builds on our earlier findings, (Journal of the American College of Cardiology Feb. 2007)," says Dr. Goldstein. "Further studies will help us to optimize the use of coronary CT versus other diagnostic methods (ECG, stress testing, echocardiography) for specific types of patients."

Beaumont is a world leader in research of CT imaging as a method of diagnosing or predicting heart attack, and for identifying unstable plaque in heart arteries that could rupture and lead to a heart attack.

About Beaumont Heart Care:

Beaumont is Michigan’s, and one of the nation’s, most experienced providers of heart care, ranking on U.S. News & World Report’s 2011 "America’s Best Hospitals" list for cardiology and heart surgery. The Beaumont Heart Center is a comprehensive, state-of-the-art facility that’s dedicated to the prevention, diagnosis and treatment of heart problems. Beaumont’s Ernst Cardiovascular Center includes six specialty clinics offering advanced and minimally invasive treatments for heart valve disease, atrial fibrillation, congestive heart failure, aortic aneurysm and dissection, plus preventive screening for adults and high school students. Beaumont’s Ministrelli Women’s Heart Center is the first in Michigan devoted exclusively to the prevention, diagnosis, and research of heart disease in women

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Brian Bierley
Beaumont Hospitals
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