According to a study published in JAMA, for patients with chest pain admitted to the ER, the use of coronary computed tomographic angiography (CCTA) or stress testing did not have a clinical benefit if the patients’ history and physical exam, electrocardiogram (ECG) and blood testing were already normal.
The use of CCTA also appeared to extend these patients’ ER stay and increase use of hospital resources, the researchers reported. CCTA is a noninvasive imaging test that can detect coronary artery disease, the underlying cause of acute coronary syndrome.
Using secondary analysis of data from a randomized clinical trial, Washington University School of Medicine (St Louis) evaluated 1,000 patients who came to emergency departments with chest pain at nine hospitals in the United States.
According to results, patients who underwent clinical evaluation plus noninvasive testing spent more time at the hospital (+7.6 hours), had more tests, were exposed to more radiation in those tests and incurred greater costs (+$323) without an apparent improvement in clinical outcomes.
There also was no difference in the rate of return emergency department visits, no missed cases of ACS in either group and no difference in major adverse cardiac events during the 28-day follow-up. More cases of ACS were diagnosed in patients who underwent noninvasive testing.