For patients with stable chest pain, utilizing coronary CT angiography before cardiac stress imaging was cost-effective, according to a microsimulation model.
The differences between cardiac stress imaging tests were small. However, strategies that included using stress echocardiography were more effective and cheaper than strategies using stress single-photon emission CT or cardiac stress MR imaging (MRI).
Lead researcher Tessa S.S. Genders, MD, PhD, of the Erasmus University Medical Center in the Netherlands, and colleagues published their findings online in the Annals of Internal Medicine on April 7.
They evaluated a target population 60-year-old patients with stable chest pain and a low to intermediate probability of having coronary artery disease (CAD). Patients were assumed to have not had CAD or undergone PCI or CABG.
The researchers modeled strategies that included no imaging, coronary CT angiography, cardiac stress imaging, coronary CT angiography with positive results followed by cardiac stress imaging and direct catheter-based coronary angiography. They based cost estimates on the published literature and expert opinion.
They found that the best strategy based on cost-effectiveness and quality-adjusted life-years (QALYs) in the U.S. began with coronary CT angiography, continued with cardiac stress imaging if necessary and ended with catheter-based coronary angiography if necessary. In addition, utilizing multiple tests was less expensive and yielded more QALYs than only using one test.
Radiation exposure was low when using stress echocardiography and cardiac stress MRI, intermediate when using coronary CT angiography and high when using single-photon emission CT.