CCTA and MPI in acute chest pain patients yield similar outcomes, resource use

After 40 months of follow-up, patients with acute chest pain had similar outcomes and resource utilization whether they were randomized to undergo coronary computed tomography angiography (CCTA) or myocardial perfusion imaging (MPI) at an inner city medical center.

The primary outcome of cardiac catheterizations not leading to revascularization was similar in the groups.

Jeffrey M. Levsky, MD, PhD, cardiothoracic radiologist from the Montefiore Medical Center in the Bronx, New York, and colleagues published their findings online in the Annals of Internal Medicine on June 9.

Although CCTA is relatively new, it has become common when evaluating patients with chest pain and can be helpful in selecting patients for cardiac catheterization and coronary revascularization, according to Levsky et al. However, they noted there are some concerns associated with CCTA, including the possibility of false-positive results leading to invasive management and high radiation dose.

In this study, the researchers analyzed 400 patients who were admitted for chest pain at telemetry-monitored wards at the Montefiore Medical Center from July 2008 through March 2012. The mean age was 57. In addition, 63 percent of patients were women, 54 percent were Hispanic, 37 percent were African-American and 95 percent were ethnic minorities. Patients were of low socioeconomic status, according to the researchers.

Patients were randomized in a 1:1 ratio to receive CCTA or MPI. Within a year, 15 percent of patients in the CCTA group (n=30) and 16 percent of patients in the MPI group (n=32) underwent cardiac catheterization within a year. In addition, 15 patients in the CCTA group and 20 patients in the MPI group did not have revascularization.

The median time to catheterization was 3.5 days in the CCTA group and two days in the MPI group. The median time to revascularization was two days and 1.5 days, respectively.

Meanwhile, the median length of stay was 28.9 hours and 30.4 hours, respectively. During the follow-up period, one patient in the CCTA group and six patients in the MPI group died, while nine patients in each group had nonfatal major adverse cardiovascular events.

The researchers said CCTA was associated with lower radiation dose and a better patient experience.

They also cited some study limitations, including that the trial included only patients from one medical center, which may limit its generalizability to other populations. Further, they noted advances in CCTA and MPI could change the effectiveness of these imaging techniques in the coming years.