title: Comparative effectiveness of coronary CT angiography vs stress cardiac imaging in patients following hospital admission for chest pain work-up: The Prospective First Evaluation in Chest Pain (PERFECT) Trial.
abstract: Because the frequency of cardiac event rates is low among chest pain patients following either performance of coronary CT angiography (CCTA) or stress testing, there is a need to better assess how these tests influence the central management decisions that follow from cardiac testing. The present study was performed to assess the relative impact of CCTA vs stress testing on medical therapies and downstream resource utilization among patients admitted for the work-up of chest pain.
  
  
  
  The admitted patients were randomized in a 1:1 ratio to either cardiac imaging stress test or CCTA. Primary outcomes were time to discharge, change in medication usage, and frequency of downstream testing, cardiac interventions, and cardiovascular re-hospitalizations. We randomized 411 patients, 205 to stress testing, and 206 to CCTA.
  
  
  
  There were no differences in time to discharge or initiation of new cardiac medications at discharge. At 1 year follow-up, there was no difference in the number of patients who underwent cardiovascular downstream tests in the CCTA vs stress test patients (21% vs 15%, P = .1) or cardiovascular hospitalizations (14% vs 16%, P = .5). However, there was a higher frequency of invasive angiography in the CCTA group (11% vs 2%, P = .001) and percutaneous coronary interventions (6% vs 0%, P < .001).
  
  
  
  Randomization of hospitalized patients admitted for chest pain work-up to either CCTA or to stress testing resulted in similar discharge times, change in medical therapies at discharge, frequency of downstream noninvasive testing, and repeat hospitalizations. However, a higher frequency of invasive coronary angiography and revascularization procedures were performed in the CCTA arm. (ClinicalTrials.gov number, NCT01604655.).
authors.affiliation: Department of Cardiovascular Medicine, Morristown Medical Center, Gagnon Cardiovascular Institute, 100 Madison Ave, Morristown, NJ, 07960, USA. uretss02@yahoo.com.
authors.forename: Seth
authors.initials: S
authors.lastname: Uretsky
authors.affiliation: Division of Cardiology, Department of Medicine, Mount Sinai St. Luke's Hospital, New York, NY, USA.
authors.forename: Edgar
authors.initials: E
authors.lastname: Argulian
authors.affiliation: Northshore LIJ Southside Hospital, Hofstra School of Medicine, NSLIJHS, Bayshore, NY, USA.
authors.forename: Azhar
authors.initials: A
authors.lastname: Supariwala
authors.affiliation: Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Shiv K
authors.initials: SK
authors.lastname: Agarwal
authors.affiliation: Division of Cardiology, Department of Medicine, Mount Sinai St. Luke's Hospital, New York, NY, USA.
authors.forename: Georges
authors.initials: G
authors.lastname: El-Hayek
authors.affiliation: Division of Cardiology, Department of Medicine, Mount Sinai St. Luke's Hospital, New York, NY, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Chavez
authors.affiliation: Division of Cardiology, Department of Medicine, Mount Sinai St. Luke's Hospital, New York, NY, USA.
authors.forename: Hira
authors.initials: H
authors.lastname: Awan
authors.affiliation: Division of Cardiology, Department of Medicine, Mount Sinai St. Luke's Hospital, New York, NY, USA.
authors.forename: Ashadevi
authors.initials: A
authors.lastname: Jagarlamudi
authors.affiliation: Division of Cardiology, Department of Medicine, Mount Sinai St. Luke's Hospital, New York, NY, USA.
authors.forename: Siva P
authors.initials: SP
authors.lastname: Puppala
authors.affiliation: Division of Cardiology, Department of Medicine, Mount Sinai St. Luke's Hospital, New York, NY, USA.
authors.forename: Randy
authors.initials: R
authors.lastname: Cohen
authors.affiliation: Division of Cardiology, Department of Medicine, Mount Sinai St. Luke's Hospital, New York, NY, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Rozanski
mesh_terms: D000368:Aged; D002637:Chest Pain / Q000000981:diagnostic imaging*; D000072226:Computed Tomography Angiography / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
keywords: Coronary computed tomography angiography; chest pain, resource utilization; stress testing