title: Real-world application of coronary computed tomography angiography and its potential effect on downstream resource utilization in evaluating angina.
abstract: 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.
authors.affiliation: Cardiology Service, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Devine
authors.forename: Todd C
authors.initials: TC
authors.lastname: Villines
authors.forename: Lance E
authors.initials: LE
authors.lastname: Sullenberger
authors.forename: Donald R
authors.initials: DR
authors.lastname: Anderson
authors.forename: Anwar K
authors.initials: AK
authors.lastname: Malik
authors.forename: Irwin M
authors.initials: IM
authors.lastname: Feuerstein
authors.forename: Allen J
authors.initials: AJ
authors.lastname: Taylor
mesh_terms: D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D000787:Angina Pectoris / Q000000981:diagnostic imaging* / Q000191:economics* / Q000453:epidemiology; D017023:Coronary Angiography / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D040841:Resource Allocation / Q000191:economics* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000191:economics* / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology