title: The CT-STAT (Coronary Computed Tomographic Angiography for Systematic Triage of Acute Chest Pain Patients to Treatment) trial.
abstract: OBJECTIVE
  The purpose of this study was to compare the efficiency, cost, and safety of a diagnostic strategy employing early coronary computed tomographic angiography (CCTA) to a strategy employing rest-stress myocardial perfusion imaging (MPI) in the evaluation of acute low-risk chest pain.
  
  
  BACKGROUND
  In the United States, >8 million patients require emergency department evaluation for acute chest pain annually at an estimated diagnostic cost of >$10 billion.
  
  
  METHODS
  This multicenter, randomized clinical trial in 16 emergency departments ran between June 2007 and November 2008. Patients were randomly allocated to CCTA (n = 361) or MPI (n = 338) as the index noninvasive test. The primary outcome was time to diagnosis; the secondary outcomes were emergency department costs of care and safety, defined as freedom from major adverse cardiac events in patients with normal index tests, including 6-month follow-up.
  
  
  RESULTS
  The CCTA resulted in a 54% reduction in time to diagnosis compared with MPI (median 2.9 h [25th to 75th percentile: 2.1 to 4.0 h] vs. 6.3 h [25th to 75th percentile: 4.2 to 19.0 h], p < 0.0001). Costs of care were 38% lower compared with standard (median $2,137 [25th to 75th percentile: $1,660 to $3,077] vs. $3,458 [25th to 75th percentile: $2,900 to $4,297], p < 0.0001). The diagnostic strategies had no difference in major adverse cardiac events after normal index testing (0.8% in the CCTA arm vs. 0.4% in the MPI arm, p = 0.29).
  
  
  CONCLUSIONS
  In emergency department acute, low-risk chest pain patients, the use of CCTA results in more rapid and cost-efficient safe diagnosis than rest-stress MPI. Further studies comparing CCTA to other diagnostic strategies are needed to optimize evaluation of specific patient subsets. (Coronary Computed Tomographic Angiography for Systematic Triage of Acute Chest Pain Patients to Treatment [CT-STAT]; NCT00468325).
authors.affiliation: William Beaumont Hospital, Royal Oak, MI, USA.
authors.forename: James A
authors.initials: JA
authors.lastname: Goldstein
authors.forename: Kavitha M
authors.initials: KM
authors.lastname: Chinnaiyan
authors.forename: Aiden
authors.initials: A
authors.lastname: Abidov
authors.forename: Stephan
authors.initials: S
authors.lastname: Achenbach
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
authors.forename: Sean W
authors.initials: SW
authors.lastname: Hayes
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
authors.forename: John R
authors.initials: JR
authors.lastname: Lesser
authors.forename: Issam A
authors.initials: IA
authors.lastname: Mikati
authors.forename: Brian J
authors.initials: BJ
authors.lastname: O'Neil
authors.forename: Leslee J
authors.initials: LJ
authors.lastname: Shaw
authors.forename: Michael Y H
authors.initials: MY
authors.lastname: Shen
authors.forename: Uma S
authors.initials: US
authors.lastname: Valeti
authors.forename: Gilbert L
authors.initials: GL
authors.lastname: Raff
mesh_terms: D000208:Acute Disease; D000328:Adult; D002637:Chest Pain / Q000000981:diagnostic imaging / Q000191:economics*; D017023:Coronary Angiography / Q000191:economics* / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000191:economics* / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000191:economics* / Q000379:methods; D016896:Treatment Outcome; D014218:Triage / Q000191:economics* / Q000379:methods