title: Coronary Computed Tomography Angiography Versus Radionuclide Myocardial Perfusion Imaging in Patients With Chest Pain Admitted to Telemetry: A Randomized Trial.
abstract: BACKGROUND
  The role of coronary computed tomography angiography (CCTA) in the management of symptomatic patients suspected of having coronary artery disease is expanding. However, prospective intermediate-term outcomes are lacking.
  
  
  OBJECTIVE
  To compare CCTA with conventional noninvasive testing.
  
  
  METHODS
  Randomized, controlled comparative effectiveness trial. (ClinicalTrials.gov: NCT00705458).
  
  
  METHODS
  Telemetry-monitored wards of an inner-city medical center.
  
  
  METHODS
  400 patients with acute chest pain (mean age, 57 years); 63% women; 54% Hispanic and 37% African-American; and low socioeconomic status.
  
  
  METHODS
  CCTA or radionuclide stress myocardial perfusion imaging (MPI).
  
  
  METHODS
  The primary outcome was cardiac catheterization not leading to revascularization within 1 year. Secondary outcomes included length of stay, resource utilization, and patient experience. Safety outcomes included death, major cardiovascular events, and radiation exposure.
  
  
  RESULTS
  Thirty (15%) patients who had CCTA and 32 (16%) who had MPI underwent cardiac catheterization within 1 year. Fifteen (7.5%) and 20 (10%) of these patients, respectively, did not undergo revascularization (difference, -2.5 percentage points [95% CI, -8.6 to 3.5 percentage points]; hazard ratio, 0.77 [CI, 0.40 to 1.49]; P = 0.44). Median length of stay was 28.9 hours for the CCTA group and 30.4 hours for the MPI group (P = 0.057). Median follow-up was 40.4 months. For the CCTA and MPI groups, the incidence of death (0.5% versus 3%; P = 0.12), nonfatal cardiovascular events (4.5% versus 4.5%), rehospitalization (43% versus 49%), emergency department visit (63% versus 58%), and outpatient cardiology visit (23% versus 21%) did not differ. Long-term, all-cause radiation exposure was lower for the CCTA group (24 versus 29 mSv; P < 0.001). More patients in the CCTA group graded their experience favorably (P = 0.001) and would undergo the examination again (P = 0.003).
  
  
  CONCLUSIONS
  This was a single-site study, and the primary outcome depended on clinical management decisions.
  
  
  CONCLUSIONS
  The CCTA and MPI groups did not significantly differ in outcomes or resource utilization over 40 months. Compared with MPI, CCTA was associated with less radiation exposure and with a more positive patient experience.
  
  
  BACKGROUND
  American Heart Association.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Levsky
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Spevack
authors.forename: Mark I
authors.initials: MI
authors.lastname: Travin
authors.forename: Mark A
authors.initials: MA
authors.lastname: Menegus
authors.forename: Paul W
authors.initials: PW
authors.lastname: Huang
authors.forename: Elana T
authors.initials: ET
authors.lastname: Clark
authors.forename: Choo-Won
authors.initials: CW
authors.lastname: Kim
authors.forename: Esther
authors.initials: E
authors.lastname: Hirschhorn
authors.forename: Katherine D
authors.initials: KD
authors.lastname: Freeman
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Tobin
authors.forename: Linda B
authors.initials: LB
authors.lastname: Haramati
mesh_terms: D006328:Cardiac Catheterization; D002637:Chest Pain / Q000209:etiology*; D057186:Comparative Effectiveness Research; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006295:Health Resources / Q000706:statistics & numerical data; D006757:Hospital Units; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D009204:Myocardial Revascularization; D017060:Patient Satisfaction; D011446:Prospective Studies; D011829:Radiation Dosage; D013686:Telemetry; D014057:Tomography, X-Ray Computed