Coronary CT angiography versus myocardial perfusion imaging for near-term quality of life, cost and radiation exposure: a prospective multicenter randomized pilot trial.

Min, JK; Koduru, S; Dunning, AM; Cole, JH; Hines, JL; Greenwell, D; Biga, C; Fanning, G; LaBounty, TM; Gomez, M; Horowitz, JM; Hadimitzsky, M; Hausleiter, J; Callister, TQ; Rosanski, AR; Shaw, LJ; Berman, DS; Lin, FY

doi:10.1016/j.jcct.2012.06.002

journal article

Dokumenttyp:: Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
Autor(en):: Min, JK; Koduru, S; Dunning, AM; Cole, JH; Hines, JL; Greenwell, D; Biga, C; Fanning, G; LaBounty, TM; Gomez, M; Horowitz, JM; Hadimitzsky, M; Hausleiter, J; Callister, TQ; Rosanski, AR; Shaw, LJ; Berman, DS; Lin, FY
Titel:: Coronary CT angiography versus myocardial perfusion imaging for near-term quality of life, cost and radiation exposure: a prospective multicenter randomized pilot trial.
Abstract:: Clinical outcomes and resource utilization after coronary computed tomography angiography (CTA) versus myocardial perfusion single-photon emission CT (MPS) in patients with stable angina and suspected coronary artery disease (CAD) has not been examined.We determined the near-term clinical effect and resource utilization after cardiac CTA compared with MPS.We randomly assigned 180 patients (age, 57.3 ± 9.8 years; 50.6% men) presenting with stable chest pain and suspected CAD at 2 sites to initial diagnostic evaluation by coronary CTA (n = 91) or MPS (n = 89). The primary outcome was near-term angina-specific health status; the secondary outcomes were incident medical and invasive treatments for CAD, CAD health care costs, and estimated radiation dose.No patients experienced myocardial infarction or death with 98.3% follow-up at 55 ± 34 days. Both arms experienced comparable improvements in angina-specific health status. Patients who received coronary CTA had increased incident aspirin (22% vs 8%; P = 0.04) and statin (7% vs -3.5%; P = 0.03) use, similar rates of CAD-related hospitalization, invasive coronary angiography, noninvasive cardiac imaging tests, and increased revascularization (8% vs 1%; P = 0.03). Coronary CTA had significantly lower total costs ($781.08 [interquartile range (IQR), $367.80-$4349.48] vs $1214.58 [IQR, $978.02-$1569.40]; P < 0.001) with no difference in induced costs. Coronary CTA had a significantly lower total estimated effective radiation dose (7.4 mSv [IQR, 5.0-14.0 mSv] vs 13.3 mSv [IQR, 13.1-38.0 mSv]; P < 0.0001) with no difference in induced radiation.In a pilot randomized controlled trial, patients with stable CAD undergoing coronary CTA and MPS experience comparable improvements in near-term angina-related quality of life. Compared with MPS, coronary CTA evaluation is associated with more aggressive medical therapy, increased coronary revascularization, lower total costs, and lower effective radiation dose.
Zeitschriftentitel:: J Cardiovasc Comput Tomogr
Jahr:: 2012
Band / Volume:: 6
Heft / Issue:: 4
Seitenangaben Beitrag:: 274-83
Sprache:: eng
Volltext / DOI:: doi:10.1016/j.jcct.2012.06.002
PubMed:: http://view.ncbi.nlm.nih.gov/pubmed/22732201
Print-ISSN:: 1934-5925
TUM Einrichtung:: Institut für Radiologie
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Institut für Diagnostische und Interventionelle Radiologie (Prof. Makowski)Institut für Radiologie und Nuklearmedizin 2012