CT-STAT trial finds CTA cheaper for solving chest pain riddles

Nov 18, 2009

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ORLANDO, FL - In those challenging cases in which a patient presents to the emergency department with chest pain but doesn't appear to have markers of a heart attack, researchers suggest that performing coronary CT angiography (CTA) might be a faster -- and less expensive -- solution than workups based on the current standard of care.

Dr. Kavitha Chinnaiyan

In a presentation at the American Heart Association (AHA) annual conference, Dr. Kavitha Chinnaiyan, a cardiologist at William Beaumont Hospital in Royal Oak, MI, reported on the results of the Coronary Computed Tomography for Systematic Triage of Acute Chest Pain Patients to Treatment (CT-STAT) trial, which compared coronary CTA to current standard of care -- rest and stress imaging studies after serial electrocardiograph and cardiac enzyme tests are inconclusive.

CT-STAT was a randomized, multicenter study conducted at 16 sites. The trial received research grant funding from Bayer Pharmaceuticals.

In the study, 750 low-risk chest pain patients were randomized to receive either CT angiography or standard-of-care workups in an attempt to produce a diagnosis. To be eligible for the study, patients had to have chest pain suspicious of angina, be 25 years of age or older, present to the emergency department within 12 hours of the onset of pain, and be randomized within 12 hours after presentation at the hospital.

The use of CTA resulted in a mean diagnosis time of 2.9 hours, compared to 6.2 hours for the standard of care. Chinnaiyan said that in addition to getting an answer sooner, the use of CT angiography:

Decreases overall radiation exposure from about 15 mSv for standard of care to 10.8 mSv for CT angiography
Decreases overall costs for patients from a mean of $3,458 for standard of care to $2,137 for CT angiography

In the study, similar numbers of these patients eventually had a final discharge diagnosis of acute coronary syndromes, Chinnaiyan said.

"Standard-of-care testing for these patients is time-consuming and resource-intensive, and the results are not always definitive," said Chinnaiyan. The possibility of missing a heart attack among these puzzling cases drives as much as 20% of the malpractice costs in the U.S., she said.

The use of "CT angiography as the primary diagnostic imaging strategy was shown to be safe and faster and cheaper than standard of care," she concluded.

By Edward Susman
AuntMinnie.com contributing writer
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