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Journal of Nuclear Cardiology

, Volume 24, Issue 4, pp 1267–1278 | Cite as

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

  • Seth UretskyEmail author
  • Edgar Argulian
  • Azhar Supariwala
  • Shiv K. Agarwal
  • Georges El-Hayek
  • Patricia Chavez
  • Hira Awan
  • Ashadevi Jagarlamudi
  • Siva P. Puppala
  • Randy Cohen
  • Alan Rozanski
Original Article

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.)

Keywords

Coronary computed tomography angiography chest pain, resource utilization stress testing 

Abbreviations

CAC

Coronary artery calcium

CAD

Coronary artery calcium score

CCTA

Coronary computed tomography angiography

ECG

Electrocardiogram

MPI

Myocardial perfusion imaging

Notes

Acknowledgments

The authors thank Jhenielle Reynolds for her excellent support in data collection.

Conflicts of interest

The authors have no conflicts of interest to declare.

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Copyright information

© American Society of Nuclear Cardiology 2016

Authors and Affiliations

  • Seth Uretsky
    • 1
    Email author
  • Edgar Argulian
    • 2
  • Azhar Supariwala
    • 3
  • Shiv K. Agarwal
    • 4
  • Georges El-Hayek
    • 2
  • Patricia Chavez
    • 2
  • Hira Awan
    • 2
  • Ashadevi Jagarlamudi
    • 2
  • Siva P. Puppala
    • 2
  • Randy Cohen
    • 2
  • Alan Rozanski
    • 2
  1. 1.Department of Cardiovascular Medicine, Morristown Medical CenterGagnon Cardiovascular InstituteMorristownUSA
  2. 2.Division of Cardiology, Department of MedicineMount Sinai St. Luke’s HospitalNew YorkUSA
  3. 3.Northshore LIJ Southside Hospital, Hofstra School of Medicine, NSLIJHSBayshoreUSA
  4. 4.Department of Cardiovascular MedicineUniversity of Arkansas for Medical SciencesLittle RockUSA

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