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miércoles, 13 de abril de 2016

Coronary CT-A vs Traditional Care

NUEM Blog
NU EM - Author: Berg A - Edited by: Weston V - Expert Reviewer: Gisondi M
Citation: [Peer-Reviewed, Web Publication] Berg A, Weston V (2016, April 12). Journal Club: Coronary CT Angiography Versus Traditional Care. [NUEM Blog. Expert Peer Review by Gisondi M]. Retrieved from http://www.nuemblog.com/blog/cta-for-chest-pain/
"Interpretation
The major outcome of the study is that they were able to demonstrate that patients with negative CCTA screening had a 1-year event rate of less than 1%. Although the study was underpowered to directly compare CCTA vs. traditional care directly, there were no statistical differences in events between the two groups
The authors hypothesized that a negative CCTA screening would lead to overall decrease in resource utilization when compared to traditional care. The rationale behind this was that prior studies showed that negative stress tests did not significantly reduce further utilization, and that proving a patient had no coronary artery disease on CCTA should cut down on return visits for chest pain. However, the data showed no statistical differences between the two groups in ED visits, cardiologist office visits, hospital admissions, other testing or medication use... 
Take Home Points
  • This was a multi-center, randomized control trial comparing CCTA vs traditional care in low to moderate risk patients, assessing safety and resource utilization after one year
  • The study randomized 1370 patients from five hospitals in Pennsylvania
  • A negative CCTA screening predicted less than a 1% risk of serious cardiac events or death from cardiac causes
  • Given the extremely low event rates in this population, the study was insufficiently powered to make a direct comparison of safety between the CCTA and Traditional Care treatment arms. 
  • Overall resource utilization (re-admissions, testing, medication use and catheterizations) between the two groups were not statistically different."