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Rationale and design of a randomized trial comparing initial stress echocardiography versus coronary CT angiography in low-to-intermediate risk emergency department patients with chest pain.
- Source :
-
Echocardiography (Mount Kisco, N.Y.) [Echocardiography] 2014 Jul; Vol. 31 (6), pp. 744-50. Date of Electronic Publication: 2013 Dec 23. - Publication Year :
- 2014
-
Abstract
- Background: Comparative effectiveness research (CER) has become a major focus of cardiovascular disease investigation to optimize diagnosis and treatment paradigms and decrease healthcare expenditures. Acute chest pain is a highly prevalent reason for evaluation in the Emergency Department (ED) that results in hospital admission for many patients and excess expense. Improvement in noninvasive diagnostic algorithms can potentially reduce unnecessary admissions.<br />Objective: To compare the performance of treadmill stress echocardiography (SE) and coronary computed tomography angiography (CTA) in ED chest pain patients with low-to-intermediate risk of significant coronary artery disease.<br />Design: This is a single-center, randomized controlled trial (RCT) comparing SE and CTA head-to-head as the initial noninvasive imaging modality. The primary outcome measured is the incidence of hospitalization. The study is powered to detect a reduction in admissions from 28% to 15% with a sample size of 400. Secondary outcomes include length of stay in the ED/hospital and estimated cost of care. Safety outcomes include subsequent visits to the ED and hospitalizations, as well as major adverse cardiovascular events at 30 days and 1 year. Patients who do not meet study criteria or do not consent for randomization are offered entry into an observational registry.<br />Conclusions: This RCT will add to our understanding of the roles of different imaging modalities in triaging patients with suspected angina. It will increase the CER evidence base comparing SE and CTA and provide insight into potential benefits and limitations of appropriate use of treadmill SE in the ED.<br /> (© 2013, Wiley Periodicals, Inc.)
- Subjects :
- Adult
Aged, 80 and over
Causality
Chest Pain diagnosis
Chest Pain epidemiology
Comorbidity
Coronary Angiography economics
Coronary Angiography statistics & numerical data
Coronary Artery Disease epidemiology
Echocardiography statistics & numerical data
Exercise Test statistics & numerical data
Female
Health Care Costs statistics & numerical data
Hospitalization economics
Humans
Incidence
Male
Middle Aged
New York epidemiology
Research Design
Risk Assessment
Tomography, X-Ray Computed statistics & numerical data
Young Adult
Chest Pain economics
Coronary Artery Disease diagnosis
Coronary Artery Disease economics
Echocardiography economics
Emergency Service, Hospital economics
Exercise Test economics
Tomography, X-Ray Computed economics
Subjects
Details
- Language :
- English
- ISSN :
- 1540-8175
- Volume :
- 31
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Echocardiography (Mount Kisco, N.Y.)
- Publication Type :
- Academic Journal
- Accession number :
- 24372760
- Full Text :
- https://doi.org/10.1111/echo.12464