| 1. Raff GL, Hoffmann U, Udelson JE. Trials of Imaging Use in the Emergency Department for Acute Chest Pain. [Review]. Jacc: Cardiovascular Imaging. 10(3):338-349, 2017 Mar. |
Review/Other-Dx |
N/A |
To review multiple randomized trials that suggest that adjunctive noninvasive imaging is safe and effective in expediting care and reducing hospital admissions for low- to intermediate-risk patients with acute chest pain (ACP). |
No results stated in abstract. |
4 |
| 2. Maffei E, Seitun S, Guaricci AI, Cademartiri F. Chest pain: coronary CT in the ER. [Review]. Br J Radiol. 89(1061):20150954, 2016. |
Review/Other-Dx |
N/A |
To summarize the current standard of care (SOC) in managing patients with chest pain with acute pain onset and suspected acute coronary syndrome (ACS) and evaluate all available evidence and future perspectives regarding the clinical role of cardiac computed tomography (CT) in the setting of acute-onset chest pain (ACP) syndromes in the ED. |
No results stated in abstract. |
4 |
| 3. Cannon CP, Battler A, Brindis RG, et al. American College of Cardiology key data elements and definitions for measuring the clinical management and outcomes of patients with acute coronary syndromes. A report of the American College of Cardiology Task Force on Clinical Data Standards (Acute Coronary Syndromes Writing Committee). J Am Coll Cardiol. 2001; 38(7):2114-2130. |
Review/Other-Tx |
N/A |
ACC key data elements and definitions for measuring the clinical management and outcomes of patients with ACSs. |
No abstract available. |
4 |
| 4. Antman EM, Hand M, Armstrong PW, et al. 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee. Circulation. 2008; 117(2):296-329. |
Review/Other-Tx |
N/A |
Focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation MI. |
No abstract available. |
4 |
| 5. Nallamothu BK, Bates ER, Herrin J, Wang Y, Bradley EH, Krumholz HM. Times to treatment in transfer patients undergoing primary percutaneous coronary intervention in the United States: National Registry of Myocardial Infarction (NRMI)-3/4 analysis. Circulation. 2005; 111(6):761-767. |
Review/Other-Tx |
4,278 patients |
To describe patterns of times to treatment in patients undergoing interhospital transfer for primary percutaneous coronary intervention in the United States. |
Among 4,278 patients transferred for primary percutaneous coronary intervention at 419 hospitals, the median total door-to-balloon time was 180 minutes, with only 4.2% of patients treated within 90 minutes, the benchmark recommended by national quality guidelines. Comorbid conditions, absence of chest pain, delayed presentation after symptom onset, less specific ECG findings, and hospital presentation during off-hours were associated with longer total door-to-balloon times. Patients at teaching hospitals in rural areas also had significantly longer times to treatment. Total door-to-balloon times for transfer patients undergoing primary percutaneous coronary intervention in the United States rarely achieve guideline-recommended benchmarks, and current decision making should take these times into account. For the full benefits of primary percutaneous coronary intervention to be realized in transfer patients, improved systems are urgently needed to minimize total door-to-balloon times. |
4 |
| 6. Haaf P, Reichlin T, Corson N, et al. B-type natriuretic peptide in the early diagnosis and risk stratification of acute chest pain. Am J Med. 124(5):444-52, 2011 May. |
Observational-Dx |
1,075 patients |
To evaluate if B-type natriuretic peptide (BNP) might be useful in the early diagnosis and risk stratification of patients with acute chest pain. |
Acute myocardial infarction was the adjudicated final diagnosis in 168 patients (16%). BNP levels at presentation were significantly higher in acute myocardial infarction as compared with patients with other diagnoses (median 224 pg/mL vs. 56 pg/mL, P <.001). The diagnostic accuracy of BNP for the diagnosis of acute myocardial infarction as quantified by the area under the receiver operating characteristic curve (AUC) (0.74; 95% confidence interval [CI], 0.70-0.78) was lower compared with cardiac troponin T at presentation (AUC 0.88; 95% CI, 0.84-0.92; P <.001). Cumulative 24-month mortality rates were 0.5% in the first, 2.1% in the second, 7.0% in the third, and 22.9% in the fourth quartile of BNP (P <.001). BNP predicted all-cause mortality independently of and more accurately than cardiac troponin T: AUC 0.81 (95% CI, 0.76-0.86) versus AUC 0.70 (95% CI, 0.62-0.77; P <.001). Net reclassification improvement for BNP was 0.10 (P=.04), and integrated discrimination improvement 0.068 (P=.01). |
2 |
| 7. Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. Circulation. 126(16):2020-35, 2012 Oct 16. |
Review/Other-Dx |
N/A |
To discuss the practice guidelines of the third universal definition of myocardial infarction. |
No results stated in the abstract. |
4 |
| 8. Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Neth Heart J 2008;16:191-6. |
Review/Other-Dx |
29 patients |
To evaluate the accuracy of the HEART score in diagnostic and therapeutic choices for chest pain in the emergency room. |
Twenty-nine patients reached one or more endpoints: an acute myocardial infarction was diagnosed in 16 patients, 20 underwent revascularisation and two died. The HEART score in the patients with and without an endpoint was 6.51+/-1.84 and 3.71+/-1.83 (p<0.0001) respectively. A HEART score of 0-3 points holds a risk of 2.5% for an endpoint and supports an immediate discharge. With a risk of 20.3%, a HEART score of 4-6 points implies admission for clinical observation. A HEART score >/=7points, with a risk of 72.7%, supports early invasive strategies. |
4 |
| 9. de Araujo Goncalves P, Ferreira J, Aguiar C, Seabra-Gomes R. TIMI, PURSUIT, and GRACE risk scores: sustained prognostic value and interaction with revascularization in NSTE-ACS. Eur Heart J. 26(9):865-72, 2005 May. |
Observational-Dx |
460 patients |
To compare the prognostic value of three (TIMI, PURSUIT, and GRACE) acute coronary syndrome (ACS) risk scores (RSs) and their ability to predict benefit from myocardial revascularization performed during initial hospitalization |
The best cut-off value for each RS, calculated with receiver operating characteristic curves, was used to assess the impact of myocardial revascularization on the combined incidence of death or MI. Death or MI at 1 year was 15.4% (32 deaths/49 MIs). The best predictive accuracy for death or MI at 1 year was obtained by the GRACE RS (AUC) [area under the curve: 0.715; confidence interval (CI: 0.672–0.756)] but the performance of the PURSUIT RS (AUC: 0.630; CI: 0.584–0.674), and TIMI RS (AUC: 0.585; CI:0.539–0.631) was also good. We found a statistically significant interaction between the risk stratified by the best cut-off value for the GRACE and PURSUIT RSs and myocardial revascularization, with a better prognosis for the high-risk patients. The high-risk patients represented 36.7, 28.7, and 57.8% of the population, for the GRACE, PURSUIT, and TIMI RSs, respectively. |
3 |
| 10. Yan AT, Yan RT, Tan M, et al. Risk scores for risk stratification in acute coronary syndromes: useful but simpler is not necessarily better. Eur Heart J. 28(9):1072-8, 2007 May. |
Observational-Dx |
1,728 patients |
To compare the discriminatory performance of the Thrombolysis in Myocardial Infarction risk score (TIMI RS), Platelet glycoprotein IIb/IIIa in Unstable angina: Receptor Suppression Using Integrilin Therapy risk score (PURSUIT RS), and Global Registry of Acute Cardiac Events risk score (GRACE RS) for in-hospital and 1 year mortality across the broad spectrum of non-ST-elevation acute coronary syndromes (ACS) and (ii) to determine their incremental prognostic utility beyond overall risk assessment by physicians. |
TIMI RS, PURSUIT RS, and GRACE RS all demonstrated good discrimination for in-hospital death (c-statistics = 0.68, 0.80, 0.81, respectively, all P < 0.001) and 1 year mortality (c-statistics = 0.69, 0.77, 0.79, respectively, all P < 0.0001). However, PURSUIT RS and GRACE RS performed significantly better than the TIMI RS in predicting in-hospital (P = 0.036 and 0.02, respectively) and 1 year (P = 0.006 and 0.001, respectively) outcomes. In multivariable analysis adjusting forthe use of in-hospital revascularization, stratification by tertiles of risk scores (into low, intermediate, and high-risk groups) furnished independent and greater prognostic information compared with risk assessment by treating physicians for 1 year outcome. |
2 |
| 11. Fu Y, Goodman S, Chang WC, Van De Werf F, Granger CB, Armstrong PW. Time to treatment influences the impact of ST-segment resolution on one-year prognosis: insights from the assessment of the safety and efficacy of a new thrombolytic (ASSENT-2) trial. Circulation. 104(22):2653-9, 2001 Nov 27. |
Observational-Tx |
13,100 patients |
To examine the utility of ST-segment resolution determined at 24 to 36 hours after fibrinolytic therapy and the impact of time to treatment on the value of ST resolution in predicting 1-year mortality rates. |
Among patients treated <2 hours after symptom onset, 55.6% had complete ST resolution, whereas 52.1% and 43% of patients treated between 2 to 4 hours and 4 to 6 hours, respectively, had complete ST resolution (P<0.001). Within each category of ST resolution, patients treated <2 hours had lower 1-year mortality rates as compared with patients treated between 2 to 4 hours or >4 hours (3.8% versus 5.2% and 6.6%, P=0.002 in complete ST resolution; 5.7% versus 8.4% and 9.9%, P=0.001 in partial ST resolution; 7.1% versus 8.7% and 13%, P=0.006 in no resolution). The extent of ST resolution was closely and inversely correlated with 1-year mortality rates (r=-0.963, P<0.001). |
1 |
| 12. Gibson CM.. Time is myocardium and time is outcomes. Circulation. 104(22):2632-4, 2001 Nov 27. |
Review/Other-Dx |
N/A |
To evaluate existing data and literature supporting the hypothesis that “time is myocardium and time is outcomes.” |
No results stated in abstract. |
4 |
| 13. Levine GN, Bates ER, Blankenship JC, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions.[Erratum appears in Circulation. 2012 Feb 28;125(8):e412 Note: Dosage error in article text]. Circulation. 124(23):e574-651, 2011 Dec 06. |
Review/Other-Dx |
N/A |
To Report the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions |
No results stated in abstract. |
4 |
| 14. Pernes JM, Dupouy P, Labbe R, et al. Management of acute chest pain: A major role for coronary CT angiography. [Review]. Diagn Interv Imaging. 96(11):1105-12, 2015 Nov. |
Review/Other-Dx |
N/A |
To review the management of acute chest pain specifically the major role of coronary CT angiography. |
No results stated in abstract. |
4 |
| 15. Welch RD, Zalenski RJ, Frederick PD, et al. Prognostic value of a normal or nonspecific initial electrocardiogram in acute myocardial infarction. JAMA. 286(16):1977-84, 2001 Oct 24-31. |
Observational-Dx |
391,208 patients |
To compare in-hospital mortality among patients with acute myocardial infarction (AMI) who have normal or nonspecific initial electrocardiograms (ECGs) with that of patients who have diagnostic ECGs. |
In-hospital mortality rates were 5.7%, 8.7%, and 11.5% while the rates of the composite of mortality and life-threatening adverse events were 19.2%, 27.5%, and 34.9% for the normal, nonspecific, and diagnostic ECG groups, respectively. After adjusting for other predictor variables, the odds of mortality for the normal ECG group was 0.59 (95% confidence interval [CI], 0.56-0.63; P<.001) and for the nonspecific group was 0.70 (95% CI, 0.68-0.72; P<.001), compared with the diagnostic ECG group. |
3 |
| 16. Pope JH, Aufderheide TP, Ruthazer R, et al. Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med. 342(16):1163-70, 2000 Apr 20. |
Review/Other-Dx |
10,689 patients |
To determine the incidence of failure to hospitalize patients who presented to the emergency department with acute cardiac ischemia (i.e., either acute myocardial infarction or unstable angina, also known as acute coronary syndromes), to identify factors related to inadvertent discharge from the emergency department, and to analyze the clinical outcomes of patients who were sent home. |
Of 10,689 patients, 17 percent ultimately met the criteria for acute cardiac ischemia (8 percent had acute myocardial infarction and 9 percent had unstable angina), 6 percent had stable angina, 21 percent had other cardiac problems, and 55 percent had noncardiac problems. Among the 889 patients with acute myocardial infarction, 19 (2.1 percent) were mistakenly discharged from the emergency department (95 percent confidence interval, 1.1 to 3.1 percent); among the 966 patients with unstable angina, 22 (2.3 percent) were mistakenly discharged (95 percent confidence interval, 1.3 to 3.2 percent). Multivariable analysis showed that patients who presented to the emergency department with acute cardiac ischemia were more likely not to be hospitalized if they were women less than 55 years old (odds ratio for discharge, 6.7; 95 percent confidence interval, 1.4 to 32.5), were nonwhite (odds ratio, 2.2; 1.1 to 4.3), reported shortness of breath as their chief symptom(odds ratio, 2.7; 1.1 to 6.5), or had a normal or nondiagnostic electrocardiogram (odds ratio, 3.3; 1.7 to 6.3). Patients with acute infarction were more likely not to be hospitalized if they were nonwhite (odds ratio for discharge, 4.5; 95 percent confidence interval, 1.8 to 11.8) or had a normal or nondiagnostic electrocardiogram (odds ratio, 7.7; 95 percent confidence interval, 2.9 to 20.2). For the patients with acute infarction, the risk-adjusted mortality ratio for those who were not hospitalized, as compared with those who were, was 1.9 (95 percent confidence interval, 0.7 to 5.2), and for the patients with unstable angina, it was 1.7 (95 percent confidence interval, 0.2 to 17.0). |
4 |
| 17. Amsterdam EA, Kirk JD, Bluemke DA, et al. Testing of low-risk patients presenting to the emergency department with chest pain: a scientific statement from the American Heart Association. Circulation. 2010; 122(17):1756-1776. |
Review/Other-Dx |
N/A |
A scientific statement from the AHA on testing of low-risk patients presenting to the ED with chest pain. |
Rest MPI has assumed an important role in the ED. CCTA has also shown promise. A negative accelerated diagnostic protocol evaluation allows discharge, whereas patients with positive findings are admitted. This approach has been found to be safe, accurate, and cost-effective in low-risk patients presenting with chest pain. |
4 |
| 18. Bhuiya FA, Pitts SR, McCaig LF. Emergency department visits for chest pain and abdominal pain: United States, 1999-2008. NCHS data brief. (43)1-8, 2010 Sep. |
Review/Other-Dx |
N/A |
To report emergency department visits for chest pain and abdominal pain. |
No results stated in abstract. |
4 |
| 19. Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J Am Coll Cardiol. 2007; 50(7):e1-e157. |
Review/Other-Tx |
N/A |
ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation MI. |
No abstract available. |
4 |
| 20. de Winter RJ, Windhausen F, Cornel JH, et al. Early invasive versus selectively invasive management for acute coronary syndromes. N Engl J Med. 2005; 353(11):1095-1104. |
Experimental-Tx |
1,200 patients |
To test the hypothesis that an early invasive strategy is superior to a selectively invasive strategy for patients who have ACSs without ST-segment elevation and with an elevated cardiac troponin T level. |
The estimated cumulative rate of the primary end point was 22.7% in the group assigned to early invasive management and 21.2% in the group assigned to selectively invasive management (RR, 1.07; 95% CI, 0.87 to 1.33; P=0.33). The mortality rate was the same in the two groups (2.5%). MI was significantly more frequent in the group assigned to early invasive management (15.0% vs 10.0%, P=0.005), but rehospitalization was less frequent in that group (7.4% vs 10.9%, P=0.04). |
1 |
| 21. Mehta SR, Cannon CP, Fox KA, et al. Routine vs selective invasive strategies in patients with acute coronary syndromes: a collaborative meta-analysis of randomized trials. JAMA. 2005; 293(23):2908-2917. |
Meta-analysis |
7 trials (n=9,212 patients) |
To conduct a meta-analysis that compares benefits and risks of routine invasive vs selective invasive strategies. |
Overall, death or MI was reduced from 663 (14.4%) of 4,604 patients in the selective invasive group to 561 (12.2%) of 4,608 patients in the routine invasive group (OR, 0.82; 95% CI, 0.72-0.93; P=.001). There was a nonsignificant trend toward fewer deaths (6.0% vs 5.5%; OR, 0.92; 95% CI, 0.77-1.09; P=.33) and a significant reduction in MI alone (9.4% vs 7.3%; OR, 0.75; 95% CI, 0.65-0.88; P<.001). Higher-risk patients with elevated cardiac biomarker levels at baseline benefited more from routine intervention, with no significant benefit observed in lower-risk patients with negative baseline marker levels. During the initial hospitalization, a routine invasive strategy was associated with a significantly higher early mortality (1.1% vs 1.8% for selective vs routine, respectively; OR, 1.60; 95% CI, 1.14-2.25; P=.007) and the composite of death or MI (3.8% vs 5.2%; OR, 1.36; 95% CI, 1.12-1.66; P=.002). But after discharge, the routine invasive strategy was associated with fewer subsequent deaths (4.9% vs 3.8%; OR, 0.76; 95% CI, 0.62-0.94; P=.01) and the composite of death or MI (11.0% vs 7.4%; OR, 0.64; 95% CI, 0.56-0.75; P<.001). At the end of follow-up, there was a 33% reduction in severe angina (14.0% vs 11.2%; OR, 0.77; 95% CI, 0.68-0.87; P<.001) and a 34% reduction in rehospitalization (41.3% vs 32.5%; OR, 0.66; 95% CI, 0.60-0.72; P<.001) with a routine invasive strategy. |
M |
| 22. Task Force Members, Montalescot G, Sechtem U, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology.[Erratum appears in Eur Heart J. 2014 Sep 1;35(33):2260-1]. Eur Heart J. 34(38):2949-3003, 2013 Oct. |
Review/Other-Dx |
N/A |
To discuss the practice guidelines on management of stable coronary artery disease through the task force on the management of stable coronary artery disease of the European Society of Cardiology. |
No results stated in abstract. |
4 |
| 23. Borges Santos M, Ferreira AM, de Araujo Goncalves P, et al. Diagnostic yield of current referral strategies for elective coronary angiography in suspected coronary artery disease-an analysis of the ACROSS registry. Rev Port Cardiol. 32(6):483-8, 2013 Jun. |
Observational-Dx |
1,892 patients |
To assess the diagnostic yield of current referral strategies for elective invasive coronary angiography (ICA). |
The study population consisted of 1892 individuals (60% male, mean age 64±11 years), of whom 1548 (82%) had a positive noninvasive test: exercise stress test (41%), stress myocardial perfusion imaging (36%), stress echocardiogram (3%) or coronary computed tomography angiography (3%). Referral without testing occurred in 18% of patients. The overall prevalence of obstructive CAD was 57%, higher among those with previous testing (58% vs. 51% without previous testing, p=0.026) and when anatomic rather than functional tests were used (81.3% vs. 57.1%, p=0.001). A positive test and conventional risk factors were all independent predictors of obstructive CAD, with adjusted odds ratios (95% confidence interval) of 1.34 (1.03–1.74) for noninvasive testing, 1.05 (1.04–1.06) for age, 3.48 (2.81–4.29) for male gender, 1.86 (1.32–2.62) for current smoking, 1.74 (1.38–2.20) for diabetes, 1.30 (1.04–1.62) for hypercholesterolemia, and 1.39 (1.08–1.80) for hypertension. |
3 |
| 24. Cremer PC, Khalaf S, Agarwal S, et al. Myocardial perfusion imaging in emergency department patients with negative cardiac biomarkers: yield for detecting ischemia, short-term events, and impact of downstream revascularization on mortality. Circ Cardiovasc Imaging. 7(6):912-9, 2014 Nov. |
Observational-Dx |
5,354 patients |
To define further the yield of rest-stress single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) to detect ischemia in patients referred from the emergency department (ED) after serial negative troponin T testing and nondiagnostic ECGs. |
In a cohort of 5354 patients (58.7% female, age 59±13, 78.6% thrombolysis in myocardial infarction [TIMI] =2), 9% had >5% and 3.6% had >10% ischemic myocardium. Among patients with TIMI scores =2, 6.1% had >5% ischemic myocardium compared with 19.6% of patients with TIMI scores =3 (P<0.001). At 30 days, 7 patients were deceased, 187 had revascularization, and 6 had revascularization for an acute myocardial infarction. Over 3.4±1.9 years of follow-up, 347 patients died. In propensity-matched groups of patients with ischemia, there was no association between early revascularization and mortality (hazard ratio, 1.00; 95% confidence interval, 0.49–2.07). |
2 |
| 25. Hartsell S, Dorais J, Preston R, et al. False-positive rates of provocative cardiac testing in chest pain patients admitted to an emergency department observation unit. Crit. pathw. cardiol.. 13(3):104-8, 2014 Sep. |
Observational-Dx |
1,276 patients |
To quantify the false-positive rate of cardiac stress testing performed as part of the routine evaluation of chest pain patients in the emergency department observation unit (EDOU) of a tertiary care center. |
Of 1276 patients evaluated, 112 (8.8%) underwent cardiac catheterization of which 56 underwent some modality of prior testing. Forty-two of 56 were subject to stress testing (30 stress echo and 12 myocardial perfusion) and 14 underwent coronary computed tomography (CCTA) prior to catheterization. False-positive rate overall was 62.5% (35/56, 95% CI, 48.5%–74.7%). False-positive rate for stress testing was 75% and 66.7% for perfusion and stress echo respectively. False-positive rate for CCTA was 42.9%. |
2 |
| 26. Patel MR, Peterson ED, Dai D, et al. Low diagnostic yield of elective coronary angiography. N Engl J Med. 2010;362(10):886-895. |
Review/Other-Dx |
398,978 patients |
To determine patterns of noninvasive testing and the diagnostic yield of catheterization among patients with suspected coronary artery disease in a contemporary national sample. |
A total of 398,978 patients were included in the study. The median age was 61 years; 52.7% of the patients were men, 26.0% had diabetes, and 69.6% had hypertension. Noninvasive testing was performed in 83.9% of the patients. At catheterization, 149,739 patients (37.6%) had obstructive CAD. No CAD (defined as <20% stenosis in all vessels) was reported in 39.2% of the patients. Independent predictors of obstructive CAD included male sex (odds ratio, 2.70; 95% CI, 2.64 to 2.76), older age (odds ratio per 5-year increment, 1.29; 95% CI, 1.28 to 1.30), presence of insulin-dependent diabetes (odds ratio, 2.14; 95% CI, 2.07 to 2.21), and presence of dyslipidemia (odds ratio, 1.62; 95% CI, 1.57 to 1.67). Patients with a positive result on a noninvasive test were moderately more likely to have obstructive CAD than those who did not undergo any testing (41.0% vs 35.0%; P<0.001; adjusted odds ratio, 1.28; 95% CI, 1.19 to 1.37). |
4 |
| 27. Rubinshtein R, Halon DA, Gaspar T, et al. Impact of 64-slice cardiac computed tomographic angiography on clinical decision-making in emergency department patients with chest pain of possible myocardial ischemic origin. Am J Cardiol. 2007; 100(10):1522-1526. |
Observational-Dx |
58 consecutive patients |
To examine the impact of contrast enhanced MDCT on clinical decision-making in patients who present to the ED with chest pain of possible ischemic origin. |
Patients underwent 64-slice contrast agent-enhanced MDCT with image reconstruction in multiple formats using retrospective electrocardiographic gating, which revealed normal (no or trivial atheroma) coronary vasculature in 15 patients, nonobstructive atheroma in 20 patients, and obstructive coronary disease (=1 luminal narrowing of =50%) in 23 patients. After MDCT, the diagnosis of ACS was revised in 18/41 patients (44%; 16 normal MDCT/widely patent stents, 2 alternative diagnoses), planned hospitalization canceled in 21/47 patients (45%; 13 normal MDCT/patent stent, 8 minor branch vessel disease), and planned early invasive strategy altered in 25/58 patients (43%; unnecessary in 20/32, advisable in 5/26 others). Effect of MDCT on clinical decisions was greater in the 36 patients without known preceding coronary disease. In 32 patients discharged from the ED (11 after initial triage, 21 patients after MDCT), there were no major adverse cardiac events (eg, death, MI, unplanned revascularization) during a 12-month follow-up period. |
3 |
| 28. Solinas L, Raucci R, Terrazzino S, et al. Prevalence, clinical characteristics, resource utilization and outcome of patients with acute chest pain in the emergency department. A multicenter, prospective, observational study in north-eastern Italy. Ital Heart J. 2003; 4(5):318-324. |
Observational-Dx |
495 patients |
To evaluate the diagnostic accuracy and costs of the actual ED triage modalities of patients with acute chest pain. |
The diagnosis of ACS was confirmed in 79% of hospitalized patients. Among the patients discharged directly from the ED 68% were immediately sent back home (69 +/- 60 min from admission) and 32% required a brief clinical observation lasting 10 +/- 6 hours and including serial electrocardiographic and myocardial injury marker assessment. The average cost of the ED triage was 189 +/- 237 ?/patient. The 1-month follow-up of the patients directly discharged from the ED revealed a 2.5% incidence of ACSs (3 acute MIs), but no deaths. |
3 |
| 29. American College of Radiology. ACR–NASCI–SIR–SPR Practice Parameter for the Performance and Interpretation of Body Computed Tomography Angiography (CTA). Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/body-cta.pdf. |
Review/Other-Dx |
N/A |
Guidance document to promote the safe and effective use of diagnostic and therapeutic radiology by describing specific training, skills and techniques. |
No abstract available. |
4 |
| 30. Emergency Department Patients With Chest Pain Writing Panel, Rybicki FJ, Udelson JE, et al. 2015 ACR/ACC/AHA/AATS/ACEP/ASNC/NASCI/SAEM/SCCT/SCMR/SCPC/SNMMI/STR/STS Appropriate Utilization of Cardiovascular Imaging in Emergency Department Patients With Chest Pain: A Joint Document of the American College of Radiology Appropriateness Criteria Committee and the American College of Cardiology Appropriate Use Criteria Task Force. J. Am. Coll. Radiol.. 13(2):e1-e29, 2016 Feb. |
Review/Other-Dx |
N/A |
To discuss the practice guidelines of appropriate utilization of cardiovascular imaging in emergency department patients with chest pain based off the American College of Radiology Appropriateness Criteria Committee and the American College of Cardiology Appropriate Use Criteria Task Force. |
No results stated in the abstract. |
4 |
| 31. Goldschlager R, Roth H, Solomon J, et al. Validation of a clinical decision rule: chest X-ray in patients with chest pain and possible acute coronary syndrome. EMERG. RADIOL.. 21(4):367-72, 2014 Aug. |
Observational-Dx |
760 patients |
To determined the prevalence of clinically significant CXR abnormalities and assessed the utility of the guidelines in a population of ED patients with chest pain and suspected ACS. |
We found that 12 % of the participants had a clinically significant chest X-ray. The guidelines had a sensitivity of 80 % (95 % CI 0.70-0.87) and specificity of 50 % (95 % CI 0.47-0.54). The positive predictive value was 18 % (95 % CI 0.15-0.22) with a 95 % negative predictive value (95 % CI 0.92-0.97). Had the ACS guidelines been applied to our patient population, the number of CXR performed would have been reduced by 47 %. This study suggests that the ACS Guidelines has the potential to reduce the numbers of unnecessary CXR performed in ED patients. However, this would come at the expense of missing a minority of significant CXR abnormalities. |
2 |
| 32. Kontos MC, Fratkin MJ, Jesse RL, Anderson FP, Ornato JP, Tatum JL. Sensitivity of acute rest myocardial perfusion imaging for identifying patients with myocardial infarction based on a troponin definition. J Nucl Cardiol. 2004; 11(1):12-19. |
Observational-Dx |
319 patients |
To determine sensitivity of acute rest MPI for identifying patients with MI based on a troponin definition. |
Of the 319 patients who had MPI and cTnI elevations, 78 had negative MPI results (sensitivity, 75%). Patients with negative MPI results had lower peak CK-MB values (15 +/- 25 ng/mL vs 45 +/- 78 ng/mL, P<.0001) and higher ejection fractions (56% +/- 15% vs 47% +/- 13%, P<.0001) and were less likely to have significant disease (55% vs 72%, P=.04) than those with positive MPI results. Increasing summed rest score was associated with larger MIs as estimated by peak CK and CK-MB values. |
3 |
| 33. Udelson JE, Beshansky JR, Ballin DS, et al. Myocardial perfusion imaging for evaluation and triage of patients with suspected acute cardiac ischemia: a randomized controlled trial. JAMA. 2002;288(21):2693-2700. |
Experimental-Dx |
2,475 patients |
Prospective randomized controlled trial to assess whether incorporating acute resting perfusion imaging into an ED evaluation strategy for patients with symptoms suggestive of acute cardiac ischemia would improve clinical decision making. |
Among patients with acute cardiac ischemia (ie, acute MI or unstable angina; n=329), there were no differences in ED triage decisions between those receiving standard evaluation and those whose evaluation was supplemented by a sestamibi scan. Among patients with acute MI (n=56), 97% vs 96% were hospitalized (RR, 1.00; 95% CI, 0.89-1.12), and among those with unstable angina (n=273), 83% vs 81% were hospitalized (RR, 0.98; 95% CI, 0.87-1.10). However, among patients without acute cardiac ischemia (n=2,146), hospitalization was 52% with usual care vs 42% with sestamibi imaging (RR, 0.84; 95% CI, 0.77-0.92). |
1 |
| 34. Klocke FJ, Baird MG, Lorell BH, et al. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging). J Am Coll Cardiol. 42(7):1318-33, 2003 Oct 01. |
Review/Other-Dx |
N/A |
To discuss the practice guidelines for the clinical use of cardiac radionuclide imaging in summarized by the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. |
No results stated in the abstract. |
4 |
| 35. Dedic A, Genders TS, Nieman K, Hunink MG. Imaging strategies for acute chest pain in the emergency department. [Review]. AJR Am J Roentgenol. 200(1):W26-38, 2013 Jan. |
Review/Other-Dx |
N/A |
To quantitatively examine existing evidence about the diagnostic performance of echocardiography, radionuclide myocardial perfusion imaging (MPH) and coronary CT angiography (CTA) in the emergency department for the diagnosis of acute coronary syndrome (ACS). |
No results stated in abstract. |
4 |
| 36. Ghatak A, Hendel RC. Role of imaging for acute chest pain syndromes. [Review]. Semin Nucl Med. 43(2):71-81, 2013 Mar. |
Review/Other-Dx |
N/A |
To compare the current imaging modalities available for patients with acute chest pain syndrome in regards to their diagnostic accuracy, feasibility and cost effectiveness. |
No results stated in the abstract. |
4 |
| 37. Lim SH, Anantharaman V, Sundram F, et al. Stress myocardial perfusion imaging for the evaluation and triage of chest pain in the emergency department: a randomized controlled trial. J Nucl Cardiol. 20(6):1002-12, 2013 Dec. |
Experimental-Dx |
1504 patients |
To assess whether adding stress myocardial perfusion imaging (SMPI) to an evaluation strategy for emergency department (ED) patients presenting with chest pain more effectively identifies patients with ACS. |
SMPI participants had a significantly lower admission rate than clinical assessment participants (10.16% vs 18.45%), with no significant between-group differences in risk of cardiac events (CEs) after 30 days (0.40% vs 0.79%) or 1 year (0.70% vs 0.99%). |
3 |
| 38. Hachamovitch R, Rozanski A, Shaw LJ, et al. Impact of ischaemia and scar on the therapeutic benefit derived from myocardial revascularization vs. medical therapy among patients undergoing stress-rest myocardial perfusion scintigraphy. Eur Heart J. 32(8):1012-24, 2011 Apr. |
Observational-Dx |
13,969 patients |
To investigate the roles of prior coronary artery disease (CAD) and extent of myocardial scar on the relationship between ischaemia, revascularization and survival. |
We identified 13,969 patients who underwent adenosine or exercise stress SPECT myocardial perfusion scintigraphy (MPS). The percent myocardium ischaemic (%I) and fixed (%F) were calculated using 5 point/20-segment MPS scoring. Patients lost to follow-up (2.8%) were excluded leaving 13 555 patients [35% with history (Hx) of known coronary artery disease (CAD), 65% exercise stress, 61% male, age 66+12]. Follow-up was performed at 12–18 months for early revascularization and at .7 years for all-cause death (ACD) (mean follow-up 8.7+3.3 years). All-cause death was modelled using Cox proportional hazards modelling adjusting for logistic-based propensity scores, MPS, revascularization, and baseline characteristics. During FU, 3893 ACD (29%, 3.3%/year) and 1226 early revascularizations (9.0%) occurred. After risk-adjustment, a three-way interaction was present between %I, early revascularization, and HxCAD, such that %I identified a survival benefit with early revascularization in patients without prior myocardial infarction (MI), whereas no such benefit was present in patients with prior MI (overall model x2 = 3932, P < 0.001; interaction P < 0.021). Further modelling revealed that after excluding patients with scar .10% total myocardium, %I identified a survival benefit in all patients. |
3 |
| 39. Shaw LJ, Weintraub WS, Maron DJ, et al. Baseline stress myocardial perfusion imaging results and outcomes in patients with stable ischemic heart disease randomized to optimal medical therapy with or without percutaneous coronary intervention. Am Heart J. 164(2):243-50, 2012 Aug. |
Observational-Dx |
1,381 patients |
To examine the relationship between baseline stress myocardial ischemia and clinical outcomes based on randomized treatment assignment. |
At baseline, moderate to severe ischemia occurred in more than one-quarter of patients (n = 468), and the incidence was comparable in both treatment groups (P = .36). The primary end point, death or myocardial infarction, was similar in the OMT and PCI + OMT treatment groups for no to mild (18% and 19%, P = .92) and moderate to severe ischemia (19% and 22%, P = .53, interaction P value = .65). There was no gradient increase in events for the overall cohort with the extent of ischemia. |
3 |
| 40. Davies R, Liu G, Sciamanna C, Davidson WR Jr, Leslie DL, Foy AJ. Comparison of the Effectiveness of Stress Echocardiography Versus Myocardial Perfusion Imaging in Patients Presenting to the Emergency Department With Low-Risk Chest Pain. Am J Cardiol. 118(12):1786-1791, 2016 Dec 15. |
Observational-Dx |
48,202 patients |
To compare clinically relevant cardiovascular outcomes and downstream resource utilization associated with stress echocardiography (SE) and myocardial perfusion imaging (MPI) in emergency department patients with low-risk chest pain. |
Compared with stress echocardiography (SE), myocardial perfusion imaging (MPI) was associated with significantly higher odds of subsequent cardiac catheterization (adjusted odds ratio [AOR] 2.15; 95% confidence interval [CI] 1.99 to 2.33) and revascularization procedures (AOR 1.58; 95% CI 1.36 to 1.85) and repeat emergency department visits (AOR 1.14; 95% CI 1.11 to 1.19). The odds of repeat testing and myocardial infarction did not differ between groups. The average cost of downstream care was significantly higher in the MPI group ($2,193.80 vs $1,631.10, p <0.0001). |
3 |
| 41. Lancellotti P, Price S, Edvardsen T, et al. The use of echocardiography in acute cardiovascular care: recommendations of the European Association of Cardiovascular Imaging and the Acute Cardiovascular Care Association. European Heart Journal Acute Cardiovascular Care. 4(1):3-5, 2015 Feb. |
Review/Other-Dx |
N/A |
To discuss the use of echocardiography in acute cardiovascular care recommended by the European Association of Cardiovascular Imaging and the Acute Cardiovascular Care Association. |
No results stated in the abstract. |
4 |
| 42. Lim SH, Sayre MR, Gibler WB. 2-D echocardiography prediction of adverse events in ED patients with chest pain. Am J Emerg Med. 2003; 21(2):106-110. |
Review/Other-Dx |
1,112 patients received echo |
To establish the efficacy of 2D echocardiography in predicting adverse cardiac events in patients presenting to the ED with possible ACS. |
Of the 1,112 patients receiving echocardiography, 18 had positive studies. None had adverse events on follow-up. Of the 1,094 patients with a negative 2-D echocardiography, 15 had adverse events (2 acute MIs, 2 coronary artery bypass graftings, and 11 percutaneous transluminal coronary angioplasties). Resting 2-D echocardiography did not predict cardiac adverse events in patients with possible ACS and non-diagnostic serial 12-lead ECG and normal serial CK-MB at the end of a 9-hour evaluation. |
4 |
| 43. Innocenti F, Cerabona P, Donnini C, Conti A, Zanobetti M, Pini R. Long-term prognostic value of stress echocardiography in patients presenting to the ED with spontaneous chest pain. Am J Emerg Med. 32(7):731-6, 2014 Jul. |
Observational-Dx |
626 patients |
To evaluate the long-term prognostic value of stress echocardiography (SE) in patients evaluated in emergency department (ED) and to determine SE parameters that best predicted outcome. |
Stress echocardiography showed inducible ischemia in 159 patients (25%); it was negative in 425 (68%) and inconclusive in 42 (7%). Patients with cardiac events more frequently showed inducible ischemia (50% vs 26%; P =.015) compared with patients with good prognosis; a normal SE (14% vs 61%) was significantly less common. At a multivariate regression analysis, an increased pWMSI (relative risk: 9.816, 95% confidence interval: 3.665-26.290; P < .0001) was independently associated with a bad outcome. Cumulative event-free survival was significantly worse with an increasing degree of peak wall motion asynergy (99% in group A1; 96%, group A2; and 88% in group A3; P= .011 between A1 and A2 groups, P = .012 between A2 and A3 groups, and P < .0001 between A1 and A3 groups). |
3 |
| 44. Nucifora G, Badano LP, Sarraf-Zadegan N, et al. Comparison of early dobutamine stress echocardiography and exercise electrocardiographic testing for management of patients presenting to the emergency department with chest pain. Am J Cardiol. 100(7):1068-73, 2007 Oct 01. |
Observational-Dx |
190 patients |
To compare the cost-effectiveness of dobutamine-atropine stress echocardiography (DASE) and electrocardiographic exercise testing (EET) implemented in emergency department accelerated diagnostic protocols for the early stratification of low-risk patients presenting with acute chest pain (ACP). |
Ninety patients (82%) in the DASE arm and 78 (88%) in the EET arm were discharged after the diagnosis of nonischemic ACP. The mean lengths of stay in the hospital were 23 + 12 and 31 + 23 hours in the DASE and EET arms, respectively (p = 0.01). No 2-month follow-up events occurred in DASE patients, and the event rate was significantly higher in EET patients (0% vs 11%, p = 0.004). The DASE strategy showed lower costs compared with the EET strategy at 1-month ($1,026 + $250 vs $1,329 + $1,288, p = 0.03) and 2-month ($1,029 + 253 vs $1,684 + $2,149, p = 0.005) follow-up. |
2 |
| 45. Hartlage G, Janik M, Anadiotis A, et al. Prognostic value of adenosine stress cardiovascular magnetic resonance and dobutamine stress echocardiography in patients with low-risk chest pain. Int J Cardiovasc Imaging. 28(4):803-12, 2012 Apr. |
Observational-Dx |
255 patients |
To validate a favorable negative prognostic value for both adenosine stress cardiovascular magnetic resonance (AS-CMR) and dobutamine stress echocardiography (DSE) in patients presenting with low-risk acute chest pain. |
Test characteristics such as sensitivity and specificity could not be evaluated as patients were not routinely evaluated with ICA. All patients completed the stress protocol without adverse events during testing. 82/89 patients (92.1%) and 164/166 patients (98.8%) had negative AS-CMR and DSE studies, respectively. Both AS-CMR and DSE had excellent negative prognostic values for the primary endpoint, 100 and 99%, respectively. |
3 |
| 46. Aldous S, Richards AM, Cullen L, Pickering JW, Than M. The incremental value of stress testing in patients with acute chest pain beyond serial cardiac troponin testing. Emerg Med J. 33(5):319-24, 2016 May. |
Observational-Dx |
1915 patients (1184 patients from ASPECT/ADAPT trial, 749 patients from 2-Hour Diagnostic Protocol for Possible Cardiac Chest Pain in the ED) |
To report the reliability and incremental value of non-invasive testing as a screening test to identify patients for angiography with a view to revascularisation. |
Of 749 patients recruited, 709 underwent exercise tolerance testing and 40 dobutamine stress echo of which 548 (73.2%) were negative, 169 (22.6%) were non-diagnostic and 32 (4.3%) were positive. Patients with positive tests (n=19 (59.4%)) were more likely to undergo index admission revascularisation than patients with non-diagnostic (n=15 (8.9%)) (p<0.001) tests who in turn were more likely undergo index admission revascularisation than those with negative tests (n=2 (0.4%)) (p<0.001). The risks of adverse events including cardiovascular death/acute myocardial infarction were low and were similar across stress test outcomes. |
2 |
| 47. Yao SS, Bangalore S, Chaudhry FA. Prognostic implications of stress echocardiography and impact on patient outcomes: an effective gatekeeper for coronary angiography and revascularization. J Am Soc Echocardiogr. 23(8):832-9, 2010 Aug. |
Observational-Dx |
3,121 patients |
To evaluate the clinical outcomes of coronary angiography, revascularization, and cardiac events in patients undergoing stress echocardiography. |
Stress echocardiographic results were normal (peak wall motion score index [pWMSI], 1.0) in 66% and abnormal (pWMSI > 1.0) in 34% of patients. The pWMSI effectively risk-stratified patients into low-risk (pWMSI, 1.0; 0.8% per year), intermediate-risk (pWMSI, 1.1-1.7; 2.6% per year), and high-risk (pWMSI >1.7; 5.5% per year) groups for future cardiac events (P < .0001). Early coronary angiography (30 days following stress echocardiography) was performed in only 35 patients (1.7%) with normal stress echocardiographic results and 267 patients (25.5%) with abnormal stress echocardiographic results (P < .0001). Late coronary revascularization (2 years following stress echocardiography) occurred in 80 patients (PCI, 2.8%; CABG, 1.1%) with pWMSI values of 1.0, 123 patients (PCI, 13.5%; CABG, 7.3%) with pWMSI values of 1.1 to 1.7, and 102 patients (PCI, 12.7%; CABG, 9.6%) with pWMSI values > 1.7. Multivariate logistic regression analysis identified pWMSI as a predictor of coronary angiography (relative risk, 2.04; 95% confidence interval, 1.67-2.5), revascularization (relative risk, 1.91; 95% confidence interval, 1.68-2.17), and cardiac events (relative risk, 2.45; 95% confidence interval, 2.09-2.88) (all P values < .0001). Patients with markedly abnormal stress echocardiographic results (pWMSI > 1.7) had a significantly higher cardiac event rate in those who did not undergo coronary revascularization (9.6% per year vs 2.9% per year, P < .05). |
2 |
| 48. Frenkel O, Riguzzi C, Nagdev A. Identification of high-risk patients with acute coronary syndrome using point-of-care echocardiography in the ED. Am J Emerg Med. 32(6):670-2, 2014 Jun. |
Review/Other-Dx |
N/A |
To assess if patients with unstable angina/non-ST elevation myocardial infarction (UA/NSTEMI) using point-of-care (POC) echocardiography performed by emergency department (ED) physicians could help identify regional wall motion abnormalities (RWMAs). |
No results stated in the abstract. |
4 |
| 49. Labovitz AJ, Noble VE, Bierig M, et al. Focused cardiac ultrasound in the emergent setting: a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians. J Am Soc Echocardiogr. 23(12):1225-30, 2010 Dec. |
Review/Other-Dx |
N/A |
This consensus statement by the American Society of Echocardiography (ASE) and the American College of Emergency Physicians (ACEP) delineates the important role of focused cardiac ultrasound (FOCUS) in patient care and treatment and emphasizes the complementary role of FOCUS to that of comprehensive echocardiography. |
No results stated in the abstract. |
4 |
| 50. Gaibazzi N, Squeri A, Reverberi C, et al. Contrast stress-echocardiography predicts cardiac events in patients with suspected acute coronary syndrome but nondiagnostic electrocardiogram and normal 12-hour troponin. J Am Soc Echocardiogr. 24(12):1333-41, 2011 Dec. |
Observational-Dx |
545 patients |
To test the hypothesis that combined contrast wall motion and myocardial perfusion echocardiographic assessment (cMCE) during stress echocardiography can predict long-term hard cardiac events in patients with suspected acute coronary syndrome (ACS), nondiagnostic ECG findings, and normal troponin. |
During a median follow-up period of 12 months, 25 cardiac events (4.6%) occurred (no deaths, 12 nonfatal myocardial infarctions, 13 episodes of unstable angina). Abnormal findings on cMCE were the most significant predictor of both hard cardiac events (hazard ratio, 22.8; 95% confidence interval, 2.9–176.7) and the combined (cardiac death, myocardial infarction, or unstable angina requiring revascularization) end point (hazard ratio, 10.7; 95% confidence interval, 3.7–31.3). The inclusion of the cMCE variable significantly improved multivariate models, determining lower Akaike information criterion values and higher discrimination ability. |
2 |
| 51. Kaul S, Senior R, Firschke C, et al. Incremental value of cardiac imaging in patients presenting to the emergency department with chest pain and without ST-segment elevation: a multicenter study. Am Heart J. 2004;148(1):129-136. |
Observational-Dx |
203 patients |
To compare contrast echocardiography with SPECT to determine incremental value of cardiac imaging in patients presenting to the emergency department with chest pain and without ST-segment elevation on the ECG. Both contrast echocardiography and SPECT readings included separate and composite assessments of both regional myocardial function and perfusion. |
Concordance between contrast-enhanced and SPECT was 77% (73%-82%) for all territories, with a higher concordance for the anterior wall of 84% (78%-89%). Regional myocardial function and composite evaluation was better on SPECT compared with contrast echocardiography, while perfusion alone was not. |
2 |
| 52. Rinkevich D, Kaul S, Wang XQ, et al. Regional left ventricular perfusion and function in patients presenting to the emergency department with chest pain and no ST-segment elevation. Eur Heart J. 26(16):1606-11, 2005 Aug. |
Observational-Dx |
1017 Patients |
To test our hypothesis that the assessment of both regional function (RF) and myocardial perfusion (MP) will provide incremental value over routine clinical and EKG evaluation in patients presenting to the ED with chest pain (CP) and without ST elevation by using myocardial contrast echocardiography (MCE), which can provide a rapid bedside assessment of RF and MP. |
Of the 1017 patients studied, 166 (16.3%) had early events. Adding RF increased the prognostic information of clinical and EKG variables significantly (Bonferroni corrected P , 0.0001) for predicting these events. When MP was added, significant additional prognostic information was obtained (Bonferroni corrected P ¼ 0.0002). All patients were followed for a median of 7.7 months (25th–75th percentiles: 2.7–12.5) Of these, 292 (28.7%) had events. Adding RF increased the prognostic information of clinical and EKG variables for determining the risk of events significantly (Bonferroni corrected P , 0.0001), which was further increased by adding MP (Bonferroni corrected P , 0.0001). |
3 |
| 53. Wei K.. Utility contrast echocardiography in the emergency department. [Review] [44 refs]. JACC Cardiovasc Imaging. 3(2):197-203, 2010 Feb. |
Review/Other-Dx |
N/A |
To discuss how echocardiography can be used to diagnose, risk stratify, and potentially reduce costs in patients with suspected acute coronary syndromes in the ED. |
No results stated in abstract. |
4 |
| 54. Dahlslett T, Karlsen S, Grenne B, et al. Early assessment of strain echocardiography can accurately exclude significant coronary artery stenosis in suspected non-ST-segment elevation acute coronary syndrome. J Am Soc Echocardiogr. 27(5):512-9, 2014 May. |
Experimental-Dx |
64 Patients |
To investigate whether myocardial strain assessment by echocardiography could exclude significant coronary artery stenosis in patients presenting with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS). |
No significant stenosis in any coronary artery was found in 35 patients (55%). Global peak systolic longitudinal strain was superior to conventional echocardiographic parameters in distinguishing patients with and without significant coronary artery stenosis (area under the curve, 0.87). Sensitivity and specificity were calculated as 0.93 and 0.78, respectively, and positive predictive value and negative predictive value as 0.74 and 0.92, respectively. Feasibility of the strain measurements was excellent, with 97% of segments analyzed. |
4 |
| 55. Eek C, Grenne B, Brunvand H, et al. Strain echocardiography predicts acute coronary occlusion in patients with non-ST-segment elevation acute coronary syndrome. Eur J Echocardiogr. 11(6):501-8, 2010 Jul. |
Observational-Dx |
150 Patients |
To test the ability to predict acute coronary occlusion in patients with NSTE-ACS, using strain echocardiography and established echocardiographic indices of LV systolic function. |
One hundred and fifty patients were examined by echocardiography immediately prior to coronary angiography, 2.2 +/- 0.7 days (mean +/- SD) after hospitalization for a first NSTE-ACS. Thirty-three patients (22%) had acute coronary occlusion. These patients had impaired left ventricular function as ejection fraction was reduced (54.9 +/- 9.6 vs. 59.1 +/- 7.6%, P = 0.02). Regional myocardial function was assessed in a 16-segment model by two methods: longitudinal strain by speckle tracking echocardiography and wall motion score (WMS) by visual assessment. Patients with acute coronary occlusion had an increased number of adjacent dysfunctional segments. The median size of the dysfunctional area by strain was 7 [inter-quartile range (IQR) 4.5-9] vs. 2 (IQR 0-5) segments (P < 0.001). An area of >or=4 adjacent dysfunctional segments (strain greater than or equal to -14%) had the best ability to identify patients with acute coronary occlusion, with sensitivity 85% and specificity 70%. |
3 |
| 56. Sarvari SI, Haugaa KH, Zahid W, et al. Layer-specific quantification of myocardial deformation by strain echocardiography may reveal significant CAD in patients with non-ST-segment elevation acute coronary syndrome. JACC Cardiovasc Imaging. 6(5):535-44, 2013 May. |
Observational-Dx |
77 Patients |
To assess whether patients with significant coronary artery disease (CAD) had reduced endocardial function assessed by layer-specific strain compared with patients without significant CAD. |
Patients with significant CAD had worse function in all 3 myocardial layers assessed by TLS and GCS compared with patients without significant CAD. Endocardial TLS (mean -14.0 ± 3.3% vs. -19.2 ± 2.2%; p < 0.001) and GCS (mean -19.3 ± 4.0% vs. -24.3 ± 3.4%; p < 0.001) were most affected. The absolute differences between endocardial and epicardial TLS and GCS were lower in patients with significant CAD (?2.4 ± 3.6% and ?6.7 ± 3.8%, respectively) than in those without significant CAD (?5.3 ± 2.1% and ?10.4 ± 3.0%; p < 0.001). This reflects a pronounced decrease in endocardial function in patients with significant CAD. A receiver-operating characteristic curve analysis showed that endocardial and mid-myocardial TLS were superior to identify significant CAD compared with epicardial TLS (p < 0.05), wall motion score index (p < 0.01), and ejection fraction (EF) (p < 0.001). |
3 |
| 57. Schroeder J, Hamada S, Grundlinger N, et al. Myocardial deformation by strain echocardiography identifies patients with acute coronary syndrome and non-diagnostic ECG presenting in a chest pain unit: a prospective study of diagnostic accuracy. Clin. res. cardiol.. 105(3):248-56, 2016 Mar. |
Observational-Dx |
268 Patients |
To identify patients at risk with suspected ACS but without ECG changes or myocardial enzyme abnormalities, using myocardial deformation imaging. |
Anatomically obstructive coronary artery disease (CAD) (=70 % diameter stenosis) was present in 110 patients (41 %). The incremental value of LVEF, WMSI, and strain parameters to relevant clinical variables was determined in nested Cox models. Baseline clinical data associated with relevant CAD were age [hazard ratio (HR) 1.31, p = 0.03], arterial hypertension (HR 1.39, p = 0.03) and diabetes (HR 1.46, p = 0.001). The addition of endocardial global circumferential strain (GCS) (HR 1.57, p < 0.001) caused the greatest increment in model power (? 2 = 43.4, p < 0.001). Optimal cut-off value was calculated as -21.7 % for GCS (sensitivity 87 %, specificity 76 %) to differentiate between these patients. |
3 |
| 58. Kuhl HP, Hanrath P. The impact of transesophageal echocardiography on daily clinical practice. Eur J Echocardiogr. 2004; 5(6):455-468. |
Review/Other-Dx |
N/A |
To review the impact of TEE in daily clinical practice and on possible future applications of the technique. |
TEE has opened a new window to the heart. Its success rate is impressive. In less than two decades it has become an integral part of pediatric and adult cardiology as well as cardiac surgery and anesthesiology. |
4 |
| 59. Hendel RC, Patel MR, Kramer CM, et al. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology. [Review] [13 refs]. J Am Coll Cardiol. 48(7):1475-97, 2006 Oct 03. |
Review/Other-Dx |
N/A |
ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac CT and cardiac MRI. The reviews assessed the risks and benefits of the imaging tests for several indications or clinical scenarios. |
No abstract available. |
4 |
| 60. Hoffmann U, Bamberg F, Chae CU, et al. Coronary computed tomography angiography for early triage of patients with acute chest pain: the ROMICAT (Rule Out Myocardial Infarction using Computer Assisted Tomography) trial. J Am Coll Cardiol. 2009; 53(18):1642-1650. |
Observational-Dx |
368 patients |
To determine the usefulness of CCTA in patients with acute chest pain. |
Among 368 patients (mean age 53 +/- 12 years, 61% men), 31 had ACS (8%). By CCTA, 50% of these patients were free of CAD, 31% had nonobstructive disease, and 19% had inconclusive or positive CT for significant stenosis. Sensitivity and NPV for ACS were 100% (n=183/368; 95% CI: 98% to 100%) and 100% (95% CI: 89% to 100%), respectively, with the absence of CAD 77% (95% CI: 59% to 90%) and 98% (n=300/368, 95% CI: 95% to 99%), respectively, with significant stenosis by CCTA. Specificity of presence of plaque and stenosis for ACS were 54% (95% CI: 49% to 60%) and 87% (95% CI: 83% to 90%), respectively. Only 1 ACS occurred in the absence of calcified plaque. Both the extent of coronary plaque and presence of stenosis predicted ACS independently and incrementally to Thrombolysis In Myocardial Infarction risk score (area under curve: 0.88, 0.82, vs 0.63, respectively; all P<0.0001). |
2 |
| 61. Goldstein JA, Gallagher MJ, O'Neill WW, Ross MA, O'Neil BJ, Raff GL. A randomized controlled trial of multi-slice coronary computed tomography for evaluation of acute chest pain. J Am Coll Cardiol. 2007; 49(8):863-871. |
Experimental-Dx |
197 patients randomized to MSCT (n=99) vs standard of care (n=98) |
To compare the safety, diagnostic efficacy, and efficiency of MSCT with standard diagnostic evaluation of low-risk acute chest pain patients. |
Both approaches were completely (100%) safe. The MSCT alone immediately excluded or identified coronary disease as the source of chest pain in 75% of patients, including 67 with normal coronary arteries and 8 with severe disease referred for invasive evaluation. The remaining 25% of patients required stress testing, owing to intermediate severity lesions or nondiagnostic scans. During the index visit, MSCT evaluation reduced diagnostic time compared with standard of care (3.4 hours vs 15.0 hours, P<0.001) and lowered costs (1,586 dollars vs 1,872 dollars, P<0.001). Importantly, MSCT patients required fewer repeat evaluations for recurrent chest pain (MSCT, 2/99 (2.0%) patients vs standard of care, 7/99 (7%) patients; P=0.10). |
2 |
| 62. Hoffmann U, Nagurney JT, Moselewski F, et al. Coronary multidetector computed tomography in the assessment of patients with acute chest pain. Circulation. 2006; 114(21):2251-2260. |
Observational-Dx |
103 patients |
Prospective study was performed in patients presenting with acute chest pain to the ED between May and July 2005 who were admitted to the hospital to rule out ACS with no ischemic ECG changes and negative initial biomarkers. |
Among 103 consecutive patients (40% female; mean age, 54+/-12 years), 14 patients had ACS. Both the absence of significant coronary artery stenosis (73/103 patients) and nonsignificant coronary atherosclerotic plaque (41/103 patients) accurately predicted the absence of ACS (NPVs, 100%). Multivariate logistic regression analyses demonstrated that adding the extent of plaque significantly improved the initial models containing only traditional risk factors or clinical estimates of the probability of ACS (c statistic, 0.73 to 0.89 and 0.61 to 0.86, respectively). Noninvasive assessment of CAD by MDCT has good performance characteristics for ruling out ACS in subjects presenting with possible myocardial ischemia to the ED and may be useful for improving early triage. |
2 |
| 63. Rubinshtein R, Halon DA, Gaspar T, et al. Usefulness of 64-slice multidetector computed tomography in diagnostic triage of patients with chest pain and negative or nondiagnostic exercise treadmill test result. Am J Cardiol. 2007; 99(7):925-929. |
Observational-Dx |
100 patients |
To examine the usefulness of 64-slice MDCT in a diagnostic triage of 100 consecutive patients (age 55.8+/-11.6 years; 57% men) with chest pain suspected to be ischemic in origin and a negative or nondiagnostic exercise treadmill test. |
MDCT showed obstructive (=50%) CAD in 29 patients; 13/59 patients (22%) with a negative and 16/41 patients (39%) with a nondiagnostic exercise treadmill test result. High-risk (left main and/or 3-vessel) CAD was present in 3.3% of patients with a negative and 4.9% with a nondiagnostic exercise treadmill test result. The 29 patients with obstructive CAD on MDCT had a higher mean Agatston calcium score (221+/-402 vs 40+/-77 U, P<0.001). Invasive coronary angiography confirmed MDCT findings in 26/29 patients (PPV 90%) and 45/54 stenotic segments (83%) in a per-segment analysis. For the 71 patients without obstructive CAD on MDCT, clinically driven invasive angiography detected CAD in 1/15 patients (1 false-negative MDCT result) and 2 of another 5 patients who were referred for invasive angiography later during a 12-month follow-up period. In the remaining 51 patients, MDCT findings effectively allowed exclusion of obstructive CAD, and there were no major adverse clinical events during follow-up. |
3 |
| 64. Stillman AE, Oudkerk M, Ackerman M, et al. Use of multidetector computed tomography for the assessment of acute chest pain: a consensus statement of the North American Society of Cardiac Imaging and the European Society of Cardiac Radiology. Eur Radiol. 2007; 17(8):2196-2207. |
Review/Other-Dx |
N/A |
A consensus statement on the use of MDCT for the assessment of acute chest pain. |
In patients with chest pain whose history, clinical findings and/or predisposing conditions suggest other life-threatening diseases, specifically acute aortic syndrome or pulmonary embolism, MDCT is proven to be the diagnostic study of choice. |
4 |
| 65. Levsky JM, Spevack DM, Travin MI, et al. Coronary Computed Tomography Angiography Versus Radionuclide Myocardial Perfusion Imaging in Patients With Chest Pain Admitted to Telemetry: A Randomized Trial. Ann Intern Med. 163(3):174-83, 2015 Aug 04. |
Observational-Dx |
400 patients |
To compare CCTA with conventional noninvasive testing. |
Thirty (15%) patients who had CCTA and 32 (16%) who had MPI underwent cardiac catheterization within 1 year. Fifteen (7.5%) and 20 (10%) of these patients, respectively, did not undergo revascularization (difference, -2.5 percentage points [95% CI, -8.6 to 3.5 percentage points]; hazard ratio, 0.77 [CI, 0.40 to 1.49]; P = 0.44). Median length of stay was 28.9 hours for the CCTA group and 30.4 hours for the MPI group (P = 0.057). Median follow-up was 40.4 months. For the CCTA and MPI groups, the incidence of death (0.5% versus 3%; P = 0.12), nonfatal cardiovascular events (4.5% versus 4.5%), rehospitalization (43% versus 49%), emergency department visit (63% versus 58%), and outpatient cardiology visit (23% versus 21%) did not differ. Long-term, all-cause radiation exposure was lower for the CCTA group (24 versus 29 mSv; P < 0.001). More patients in the CCTA group graded their experience favorably (P = 0.001) and would undergo the examination again (P = 0.003). |
2 |
| 66. Linde JJ, Hove JD, Sorgaard M, et al. Long-Term Clinical Impact of Coronary CT Angiography in Patients With Recent Acute-Onset Chest Pain: The Randomized Controlled CATCH Trial. JACC Cardiovasc Imaging. 8(12):1404-1413, 2015 Dec. |
Experimental-Dx |
576 patients |
To investigate the longterm clinical impact of a coronary computed tomographic angiography (CTA)-guided treatment strategy in patients with recent acute-onset chest pain compared to standard care. |
We randomized 299 patients to coronary CTA-guided strategy and 301 to standard care. After inclusion, 24 patients withdrew their consent. The median (interquartile range) follow-up duration was 18.7 (range 16.8 to 20.1) months. In the coronary CTA-guided group, 30 patients (11%) had a primary endpoint versus 47 patients (16%) in the standard care group (p = 0.04; hazard ratio [HR]: 0.62 [95% confidence interval: 0.40 to 0.98]). A major adverse cardiac event (cardiac death, MI, hospitalization for UAP, and late symptom-driven revascularization) was observed in 5 patients (2 MIs, 3 UAPs) in the coronary CTA-guided group versus 14 patients (1 cardiac death, 7 MIs, 5 UAPs, 1 late symptom-driven revascularization) in the standard care group (p = 0.04; HR: 0.36 [95% CI: 0.16 to 0.95]). Differences in cardiac death and MI (8 vs. 2) were insignificant (p = 0.06). |
2 |
| 67. Pena E, Rubens F, Stiell I, Peterson R, Inacio J, Dennie C. Efficiency and safety of coronary CT angiography compared to standard care in the evaluation of patients with acute chest pain: a Canadian study. EMERG. RADIOL.. 23(4):345-52, 2016 Aug. |
Observational-Dx |
258 Patients |
To compare the efficiency and safety of cardiac computed tomographic angiography (CCTA) to standard care in patients presenting to the ED with low- to intermediate-risk chest pain. |
We enrolled 258 patients: 130 in the standard care group and 128 in the cardiac CT-based management group. The cardiac CT group had a shorter time to diagnosis of 7.1 h (IQR 5.8-14.0) compared to 532.9 h (IQR 312.8-960.5) for the standard care group (p?<?0.0001) but had a longer length of stay in the ED of 7.9 h (IQR 6.5-10.8) versus 5.5 h (IQR 3.9-7.7) (p?<?0.0001). The MACE rate was 1.6 % in the standard care group and 0 % in the cardiac CT group. |
3 |
| 68. Truong QA, Schulman-Marcus J, Zakroysky P, et al. Coronary CT Angiography Versus Standard Emergency Department Evaluation for Acute Chest Pain and Diabetic Patients: Is There Benefit With Early Coronary CT Angiography? Results of the Randomized Comparative Effectiveness ROMICAT II Trial. Journal of the American Heart Association. 5(3):e003137, 2016 Mar 22. |
Observational-Dx |
1000 Patients |
To determine if cardiac computed tomography angiography (CCTA) reduces emergency department length of stay compared with standard evaluation in patients with diabetes mellitus (DM) and higher cardiovascular risk. Specifically, we compared the differences in effectiveness and safety, including downstream testing and radiation exposure, between an early CCTA and standard evaluation in patients with and without DM who presented to the ED with chest pain suggestive of acute coronary syndrome (ACS). |
In this prespecified analysis of the Rule Out Myocardial Ischemia/Infarction by Computer Assisted Tomography (ROMICAT II) multicenter trial, we randomized 1000 patients (17% diabetic) with symptoms suggestive of acute coronary syndrome to CCTA or standard evaluation. The rate of acute coronary syndrome was 8% in both diabetic and nondiabetic patients (P=1.0). Length of stay was unaffected by the CCTA strategy for diabetic patients (23.9 versus 27.2 hours, P=0.86) but was reduced for nondiabetic patients compared with standard evaluation (8.4 versus 26.5 hours, P<0.0001; P interaction=0.004). CCTA resulted in 3-fold more direct emergency department discharge in both groups (each P=0.0001, P interaction=0.27). No difference in hospital admissions was seen between the 2 strategies in diabetic and nondiabetic patients (P interaction=0.09). Both groups had more downstream testing and higher radiation doses with CCTA, but these were highest in diabetic patients (all P interaction=0.04). Diabetic patients had fewer normal CCTAs than nondiabetic patients (32% versus 50%, P=0.003) and similar normalcy rates with standard evaluation (P=0.70). Notably, 66% of diabetic patients had no or mild stenosis by CCTA with short length of stay comparable to that of nondiabetic patients (P=0.34), whereas those with >50% stenosis had a high prevalence of acute coronary syndrome, invasive coronary angiography, and revascularization. |
2 |
| 69. Goldstein JA, Chinnaiyan KM, Abidov A, et al. The CT-STAT (Coronary Computed Tomographic Angiography for Systematic Triage of Acute Chest Pain Patients to Treatment) trial. J Am Coll Cardiol. 58(14):1414-22, 2011 Sep 27. |
Experimental-Dx |
699 patients randomized to CCTA (n=361) or MPI (n=338) |
To compare the efficiency, cost, and safety of a diagnostic strategy employing early CCTA to a strategy employing rest-stress MPI in the evaluation of acute low-risk chest pain. |
The CCTA resulted in a 54% reduction in time to diagnosis compared with MPI (median 2.9 h [25th to 75th percentile: 2.1 to 4.0 h] vs 6.3 h [25th to 75th percentile: 4.2 to 19.0 h], P<0.0001). Costs of care were 38% lower compared with standard (median $2,137 [25th to 75th percentile: $1,660 to $3,077] vs $3,458 [25th to 75th percentile: $2,900 to $4,297], P<0.0001). The diagnostic strategies had no difference in major adverse cardiac events after normal index testing (0.8% in the CCTA arm vs 0.4% in the MPI arm, P=0.29). |
3 |
| 70. Hoffmann U, Truong QA, Schoenfeld DA, et al. Coronary CT angiography versus standard evaluation in acute chest pain. N Engl J Med. 367(4):299-308, 2012 Jul 26. |
Experimental-Dx |
1,000 patients randomized to CCTA (n=501) and standard evaluation (n=499) |
To compare the effectiveness of a CCTA-based evaluation strategy with that of standard evaluation in the ED for patients with symptoms suggestive of an ACS and to evaluate the downstream testing, cost, and radiation exposure associated with CCTA. |
The rate of ACSs among 1,000 patients with a mean (± standard deviation) age of 54 ± 8 years (47% women) was 8%. After early CCTA, as compared with standard evaluation, the mean length of stay in the hospital was reduced by 7.6 hours (P<0.001) and more patients were discharged directly from the ED (47% vs 12%, P<0.001). There were no undetected ACSs and no significant differences in major adverse cardiovascular events at 28 days. After CCTA, there was more downstream testing and higher radiation exposure. The cumulative mean cost of care was similar in the CCTA group and the standard evaluation group ($4,289 and $4,060, respectively; P=0.65). |
1 |
| 71. Litt HI, Gatsonis C, Snyder B, et al. CT angiography for safe discharge of patients with possible acute coronary syndromes. N Engl J Med. 2012; 366(15):1393-1403. |
Experimental-Dx |
1,370 patients: 908 in the CCTA group and 462 in the group receiving traditional care |
To determine the safety and efficiency of a CCTA-based strategy. The study compared a CCTA-based strategy with traditional “rule out” approaches for low-to-intermediate- risk patients presenting to the ED with chest pain and possible ACS. |
Of 640 patients with a negative CCTA examination, none died or had a MI within 30 days (0%; 95% CI, 0 to 0.57). As compared with patients receiving traditional care, patients in the CCTA group had a higher rate of discharge from the ED (49.6% vs 22.7%; difference, 26.8 percentage points; 95% CI, 21.4 to 32.2), a shorter length of stay (median, 18.0 hours vs 24.8 hours; P<0.001), and a higher rate of detection of coronary disease (9.0% vs 3.5%; difference, 5.6 percentage points; 95% CI, 0 to 11.2). There was one serious adverse event in each group. |
1 |
| 72. Takakuwa KM, Keith SW, Estepa AT, Shofer FS. A meta-analysis of 64-section coronary CT angiography findings for predicting 30-day major adverse cardiac events in patients presenting with symptoms suggestive of acute coronary syndrome. Acad Radiol. 18(12):1522-8, 2011 Dec. |
Meta-analysis |
9 studies (1,559 patients) |
To determine the accuracy of 64-section CCTA in predicting 30 day major adverse cardiac events for patients presenting with symptoms concerning for ACS. |
Patients ranged from low to intermediate risk for ACS. All had initial inconclusive ECGs and negative cardiac biomarker results. A total of 14.8% of patients had a positive CCTA result. The pooled sensitivity was 93.3% (95% CI, 88.3%-96.6%), specificity was 89.9% (95% CI, 88.3%-91.3%), PPV was 48.1% (95% CI, 42.5%-53.8%), and NPV was 99.3% (95% CI, 98.7%-99.6%). 64-section CCTA had a 99.3% NPV in excluding major adverse cardiac events for 30 days after initial symptom presentation in 85.2% of our study population. Although the value of 64-section CCTA is best for identifying patients who can safely be discharged home, it is less useful for patients who have positive results. |
M |
| 73. Budoff MJ, Dowe D, Jollis JG, et al. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol. 2008;52(21):1724-1732. |
Experimental-Dx |
230 patients |
To evaluate the diagnostic accuracy of electrocardiographically gated 64-multidetector row coronary computed tomographic angiography (CCTA) in individuals without known coronary artery disease (CAD). |
On a patient-based model, the sensitivity, specificity, and positive and negative predictive values to detect > or =50% or > or =70% stenosis were 95%, 83%, 64%, and 99%, respectively, and 94%, 83%, 48%, 99%, respectively. No differences in sensitivity and specificity were noted for nonobese compared with obese subjects or for heart rates < or =65 beats/min compared with >65 beats/min, whereas calcium scores >400 reduced specificity significantly. |
1 |
| 74. Cury RC, Budoff M, Taylor AJ. Coronary CT angiography versus standard of care for assessment of chest pain in the emergency department. [Review]. J Cardiovasc Comput Tomogr. 7(2):79-82, 2013 Mar-Apr. |
Review/Other-Dx |
N/A
|
To discuss the review of three large randomized trials (CT-STAT, ACRIN-PA, and ROMICAT II) have compared a coronary CTA strategy with current standard of care evaluations in >3000 patients. |
These trials provide definitive evidence for the use of coronary CTA in the emergency department in patients with a low-to-intermediate pretest probability of coronary artery disease. Clinical practice guidelines that recommend the use of coronary CTA in the emergency department are warranted. |
4 |
| 75. Cury RC, Feuchtner GM, Batlle JC, et al. Triage of patients presenting with chest pain to the emergency department: implementation of coronary CT angiography in a large urban health care system. AJR Am J Roentgenol. 200(1):57-65, 2013 Jan. |
Observational-Dx |
529 patients |
A prospective study was to determine whether coronary CTA is a reliable and safe assessment tool for the triage of patients presenting with chest pain and a low-to-intermediate risk of ACS (thrombolysis in myocardial infarction [TIMI] risk score = 2) to the ED of a large urban health care system. |
Three hundred seventeen patients (59.9%) with negative CTA findings and 151 (28.5%) with mild stenosis were discharged from the ED with a very low downstream testing rate and a very low MACE rate (negative predictive value = 99.8%). Twenty-five patients (4.7%) had moderate stenosis (n = 17 undergoing further testing). Thirty-six patients (6.8%) had stenosis of 70% or greater by CTA (n = 34 positive by invasive angiography or SPECT-myocardial perfusion imaging). The sensitivity of CTA was 94%. The rate of MACEs in patients with stenosis of 70% or greater (8.3%) was significantly higher (p < 0.001) than in patients with negative CTA findings (0%) or those with mild stenosis (0.2%). A 51% decrease in LOS-from 28.8 to 14.0 hours--was noted after implementation of the dedicated chest pain protocol (p < 0.001). |
3 |
| 76. Romero J, Husain SA, Holmes AA, et al. Non-invasive assessment of low risk acute chest pain in the emergency department: A comparative meta-analysis of prospective studies. Int J Cardiol. 187:565-80, 2015. |
Meta-analysis |
37 Studies (7800 Patients) |
To compare the diagnostic accuracy of cardiac computed tomographic angiography (CCTA), stress echocardiography (SE) and radionuclide single photon emission computed tomography (SPECT) for the assessment of chest pain in emergency department (ED) setting. |
Thirty-seven studies (15 CCTA, 9 SE, 13 SPECT) comprising a total of 7800 patients fulfilled inclusion criteria. The respective weighted mean sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and total diagnostic accuracy for CCTA were: 95%, 99%, 84%, 100% and 99%, for SE were: 84%, 94%, 73%, 96% and 96%, and for SPECT were: 85%, 86%, 57%, 95% and 88%. There was no significant difference between modalities in terms of NPV. Bivariate analysis revealed that CCTA had statistically greater sensitivity, specificity, PPV and overall diagnostic accuracy when compared to SE and SPECT. |
Inadequate |
| 77. Body R, Burrows G, Carley S, Lewis PS. Rapid exclusion of acute myocardial infarction in patients with undetectable troponin using a sensitive troponin I assay. Ann Clin Biochem. 52(Pt 5):543-9, 2015 Sep. |
Observational-Dx |
414 Patients |
To determine whether troponin concentrations below the LoD of a contemporary sensitive assay (Siemens ADVIA Centaur troponin I Ultra) could be used, either alone or in combination with the ECG, to exclude a diagnosis of AMI at the time of initial presentation to the ED. |
Of 414 participants, 70 (16.9%) had acute myocardial infarction and 205 (49.5%) had initial s-cTnI concentrations below the limit of detection. Using the limit of detection as a 'rule out' cut-off gave a sensitivity of 94.3% (95% CI 86.0-98.4%) for acute myocardial infarction. If only patients with s-cTnI below the limit of detection and no electrocardiogram ischaemia were considered to have acute myocardial infarction 'ruled out' (41.8% of the cohort, n?=?174), sensitivity would rise to 97.1% (90.1-99.7%) and negative predictive value to 98.8% (95.9-99.9%). |
2 |
| 78. Dedic A, Lubbers MM, Schaap J, et al. Coronary CT Angiography for Suspected ACS in the Era of High-Sensitivity Troponins: Randomized Multicenter Study. Journal of the American College of Cardiology. 67(1):16-26, 2016 Jan 05. |
Observational-Dx |
500 Patients |
To assess whether a diagnostic strategy supplemented by early CCTA improves clinical effectiveness compared with contemporary SOC. |
The study population consisted of 500 patients, of whom 236 (47%) were women (mean age 54 ± 10 years). There was no difference in the primary endpoint (22 [9%] patients underwent coronary revascularization within 30 days in the CCTA group and 17 [7%] in the SOC group [p = 0.40]). Discharge from the ED was not more frequent after CCTA (65% vs. 59%, p = 0.16), and length of stay was similar (6.3 h in both groups; p = 0.80). The CCTA group had lower direct medical costs (€337 vs. €511, p < 0.01) and less outpatient testing after the index ED visit (10 [4%] vs. 26 [10%], p < 0.01). There was no difference in incidence of undetected ACS. |
3 |
| 79. Dedic A, Nieman K, Hoffmann U, Ferencik M. Is there still a role for cardiac CT in the emergency department in the era of highly-sensitive troponins?. [Review]. Minerva Cardioangiol. 65(3):214-224, 2017 Jun. |
Review/Other-Dx |
N/A |
To provide an oversight on what is known about cardiac CT in acute chest presentations, and to discuss the changing role of cardiac CT in the era of highly-sensitive troponins (hsTn) and the possibility of their combined use in the work-up of suspected ACS patients. |
No results stated in abstract. |
4 |
| 80. Ferencik M, Liu T, Mayrhofer T, et al. hs-Troponin I Followed by CT Angiography Improves Acute Coronary Syndrome Risk Stratification Accuracy and Work-Up in Acute Chest Pain Patients: Results From ROMICAT II Trial. Jacc: Cardiovascular Imaging. 8(11):1272-1281, 2015 Nov. |
Observational-Dx |
160 Patients |
To compare the diagnostic accuracy of conventional troponin/traditional coronary artery disease (CAD) assessment and highly sensitive troponin (hsTn) I/advanced CAD assessment for acute coronary syndrome (ACS) during the index hospitalization. |
Of 160 patients (mean age: 53 ± 8 years, 40% women) 10.6% were diagnosed with ACS. The ACS rate in patients with hsTnI below the limit of detection (n = 9, 5.6%), intermediate (n = 139, 86.9%), and above the 99th percentile (n = 12, 7.5%) was 0%, 8.6%, and 58.3%, respectively. Absence of =50% stenosis and high-risk plaque ruled out ACS in patients with intermediate hsTnI (n = 87, 54.4%; ACS rate 0%), whereas patients with both =50% stenosis and high-risk plaque were at high risk (n = 13, 8.1%; ACS rate 69.2%) and patients with either =50% stenosis or high-risk plaque were at intermediate risk for ACS (n = 39, 24.4%; ACS rate 7.7%). hsTnI/advanced coronary CTA assessment significantly improved the diagnostic accuracy for ACS as compared to conventional troponin/traditional coronary CTA (area under the curve 0.84, 95% confidence interval [CI]: 0.80 to .88 vs. 0.74, 95% CI: 0.70 to 0.78; p < 0.001). |
4 |
| 81. Neglia D, Rovai D, Caselli C, et al. Detection of significant coronary artery disease by noninvasive anatomical and functional imaging. Circ Cardiovasc Imaging. 8(3), 2015 Mar. |
Observational-Dx |
475 Patients |
To assess the relative accuracy of commonly used imaging techniques for identifying patients with significant CAD. |
Significant CAD was present in 29% of patients. In a patient-based analysis, coronary computed tomographic angiography had the highest diagnostic accuracy, the area under the receiver operating characteristics curve being 0.91 (95% confidence interval, 0.88-0.94), sensitivity being 91%, and specificity being 92%. Myocardial perfusion imaging had good diagnostic accuracy (area under the curve, 0.74; confidence interval, 0.69-0.78), sensitivity 74%, and specificity 73%. Wall motion imaging had similar accuracy (area under the curve, 0.70; confidence interval, 0.65-0.75) but lower sensitivity (49%, P<0.001) and higher specificity (92%, P<0.001). The diagnostic accuracy of myocardial perfusion imaging and wall motion imaging were lower than that of coronary computed tomographic angiography (P<0.001). |
2 |
| 82. Chen MY, Rochitte CE, Arbab-Zadeh A, et al. Prognostic Value of Combined CT Angiography and Myocardial Perfusion Imaging versus Invasive Coronary Angiography and Nuclear Stress Perfusion Imaging in the Prediction of Major Adverse Cardiovascular Events: The CORE320 Multicenter Study. Radiology. 284(1):55-65, 2017 Jul. |
Observational-Dx |
379 Patients |
To compare the prognostic importance (time to major adverse cardiovascular event [MACE]) of combined computed tomography (CT) angiography and CT myocardial stress perfusion imaging with that of combined invasive coronary angiography (ICA) and stress single photon emission CT myocardial perfusion imaging. |
An MACE (49 revascularizations, five myocardial infarctions, one cardiac death, nine hospitalizations for chest pain or congestive heart failure, and one arrhythmia) occurred in 51 of 379 patients (13.5%). The 2-year MACE-free rates for combined CT angiography and CT perfusion findings were 94% negative for coronary artery disease (CAD) versus 82% positive for CAD and were similar to combined ICA and single photon emission CT findings (93% negative for CAD vs 77% positive for CAD, P < .001 for both). Event-free rates for CT angiography and CT perfusion versus ICA and single photon emission CT for either positive or negative results were not significantly different for MACE or late MACE (P > .05 for all). The area under the receiver operating characteristic curve (AUC) for combined CT angiography and CT perfusion (AUC = 68; 95% confidence interval [CI]: 62, 75) was similar (P = .36) to that for combined ICA and single photon emission CT (AUC = 71; 95% CI: 65, 79) in the identification of MACE at 2-year follow-up. |
3 |
| 83. Feuchtner GM, Plank F, Pena C, et al. Evaluation of myocardial CT perfusion in patients presenting with acute chest pain to the emergency department: comparison with SPECT-myocardial perfusion imaging. Heart. 98(20):1510-7, 2012 Oct. |
Observational-Dx |
76 Patients |
To determine whether evaluation of resting myocardial CT perfusion (CTP) from coronary CT angiography (CTA) datasets in patients presenting with chest pain (CP) to the emergency department (ED), might have added value to coronary CTA. |
CTP demonstrated a sensitivity of 92% and 89%, specificity of 95% and 99%, positive predictive value (PPV) of 80% and 82% and negative predictive value (NPV) of 98% and 99% for each patient and for each segment, respectively. CTA showed an accuracy of 92%, sensitivity of 70.4%, specificity of 95.5%, PPV 67.8%, and NPV of 95% compared with SPECT-MPI. When CTP findings were added to CTA the PPV improved from 67% to 90.1%. |
4 |
| 84. Linde JJ, Sorgaard M, Kuhl JT, et al. Prediction of clinical outcome by myocardial CT perfusion in patients with low-risk unstable angina pectoris. Int J Cardiovasc Imaging. 33(2):261-270, 2017 Feb. |
Observational-Dx |
240 Patients |
To evaluate the ability of adenosine stress CTP findings to predict mid-term major adverse cardiac events (MACE). |
In 240 patients with acute-onset chest pain, yet normal electrocardiograms and troponins, a clinically blinded adenosine stress CTP scan was performed in addition to conventional diagnostic evaluation. A reversible perfusion defect (PD) was found in 38 patients (16?%) and during a median follow-up of 19 months (range 12-22 months) 25 patients (10?%) suffered a MACE (cardiac death, non-fatal myocardial infarction and revascularizations). Accuracy for the prediction of MACE expressed as the area under curve (AUC) on receiver-operating characteristic curves was 0.88 (0.83-0.92) for visual assessment of a PD and 0.80 (0.73-0.85) for stress TPR (transmural perfusion ratio). After adjustment for the pretest probability of obstructive coronary artery disease, both detection of a PD and stress TPR were significantly associated with MACE with an adjusted hazard ratio of 39 (95?% confidence interval 11-134), p?<?0.0001, for visual interpretation and 0.99 (0.98-0.99) for stress TPR, p?<?0.0001. Patients with a PD volume covering >10?% of the LV myocardium had a worse prognosis compared to patients with a PD covering <10?% of the LV myocardium, p?=?0.0002. The optimal cut-off value of the myocardial PD extent to predict MACE was 5.3?% of the left ventricle [sensitivity 84?% (64-96), specificity 95?% (91-97)]. |
4 |
| 85. Rochitte CE, George RT, Chen MY, et al. Computed tomography angiography and perfusion to assess coronary artery stenosis causing perfusion defects by single photon emission computed tomography: the CORE320 study. Eur Heart J 2014;35:1120-30. |
Experimental-Dx |
381 patients |
To evaluate the diagnostic power of integrating the results of computed tomography angiography (CTA) and CT myocardial perfusion (CTP) to identify coronary artery disease (CAD) defined as a flow limiting coronary artery stenosis causing a perfusion defect by single photon emission computed tomography (SPECT). |
The prevalence of obstructive CAD defined by combined ICA-SPECT/MPI and ICA alone was 38 and 59%, respectively. The patient-based diagnostic accuracy defined by the area under the receiver operating characteristic curve (AUC) of integrated CTA-CTP for detecting or excluding flow-limiting CAD was 0.87 [95% confidence interval (CI): 0.84-0.91]. In patients without prior myocardial infarction, the AUC was 0.90 (95% CI: 0.87-0.94) and in patients without prior CAD the AUC for combined CTA-CTP was 0.93 (95% CI: 0.89-0.97). For the combination of a CTA stenosis >/=50% stenosis and a CTP perfusion deficit, the sensitivity, specificity, positive predictive, and negative predicative values (95% CI) were 80% (72-86), 74% (68-80), 65% (58-72), and 86% (80-90), respectively. For flow-limiting disease defined by ICA-SPECT/MPI, the accuracy of CTA was significantly increased by the addition of CTP at both the patient and vessel levels. |
1 |
| 86. Branch KR, Busey J, Mitsumori LM, et al. Diagnostic performance of resting CT myocardial perfusion in patients with possible acute coronary syndrome. AJR Am J Roentgenol. 200(5):W450-7, 2013 May. |
Observational-Dx |
105 Patients |
To study whether adding resting CT myocardial perfusion imaging improved the detection of acute coronary syndrome. |
A total of 105 patients were enrolled. Of the nine (9%) patients with acute coronary syndrome, all had obstructive CT stenoses but only three had abnormal CT perfusion. CT perfusion was normal in all other patients. To detect acute coronary syndrome, CT angiography had 100% sensitivity, 89% specificity, and a positive predictive value of 45%. For CT perfusion, specificity and positive predictive value were each 100%, and sensitivity was 33%. Combined cardiac CT and CT perfusion had similar specificity but a higher positive predictive value (100%) than did CT angiography. |
3 |
| 87. Pursnani A, Lee AM, Mayrhofer T, et al. Early resting myocardial computed tomography perfusion for the detection of acute coronary syndrome in patients with coronary artery disease. Circulation. Cardiovascular imaging. 8(3):e002404, 2015 Mar. |
Observational-Dx |
183 Patients |
To determine the diagnostic accuracy of early resting CTP (rCTP), the incremental value beyond obstructive coronary artery disease (CAD; =50% stenosis), and to compare early rCTP to late stress SPECT-MPI in patients with CAD presenting with suspicion of ACS to the emergency department. |
In this prespecified subanalysis of 183 patients (58.1±10.2 years; 33% women), we included patients with any CAD by coronary computed tomography angiography (CCTA) from Rule Out Myocardial Infarction Using Computer-Assisted Tomography I. rCTP was assessed semiquantitatively, blinded to CAD interpretation. Overall, 31 had ACS and 48 had abnormal rCTP. Sensitivity and specificity of rCTP for ACS were 48% (95% confidence interval [CI], 30%-67%) and 78% (95% CI, 71%-85%), respectively. rCTP predicted ACS (adjusted odds ratio, 3.40 [95% CI, 1.37-8.42]; P=0.008) independently of obstructive CAD, and sensitivity for ACS increased from 77% (95% CI, 59%-90%) for obstructive CAD to 90% (95% CI, 74%-98%) with addition of rCTP (P=0.05). In a subgroup undergoing late rest/stress SPECT-MPI (n=81), CCTA/rCTP had noninferior discriminatory value to CCTA/SPECT-MPI (area under the curve, 0.88 versus 0.90; P=0.64) using a noninferiority margin of 10%. |
2 |
| 88. Coenen A, Rossi A, Lubbers MM, et al. Integrating CT Myocardial Perfusion and CT-FFR in the Work-Up of Coronary Artery Disease. JACC Cardiovasc Imaging. 10(7):760-770, 2017 Jul. |
Observational-Dx |
74 Patients |
To investigate the individual and combined accuracy of dynamic computed tomography (CT) myocardial perfusion imaging (MPI) and computed tomography angiography (CTA) fractional flow reserve (FFR) for the identification of functionally relevant coronary artery disease (CAD). |
Sensitivity, specificity, and accuracy were 73% (95% confidence interval [CI]: 61% to 86%), 68% (95% CI: 56% to 80%), and 70% (95% CI: 62% to 79%) for CT MPI and 82% (95% CI: 72% to 92%), 60% (95% CI: 48% to 72%), and 70% (63% to 80%) for CTA FFR. For CT MPI integrated with CTA FFR, diagnostic accuracy was 79% (95% CI: 71% to 87%), with improvement of the area under the curve from 0.78 to 0.85 (p < 0.05). Accuracy of the stepwise approach was 77%. |
3 |
| 89. Douglas PS, De Bruyne B, Pontone G, et al. 1-Year Outcomes of FFRCT-Guided Care in Patients With Suspected Coronary Disease: The PLATFORM Study. J Am Coll Cardiol. 68(5):435-45, 2016 Aug 02. |
Observational-Dx |
584 patients |
To determine the 1-year clinical, economic, and quality-of-life (QOL) outcomes of using fractional flow reserve using computed tomographic angiography (CTA)(FFRCT) instead of usual care. |
Patients averaged 61 years of age with a mean 49% pre-test probability of coronary artery disease. At 1 year, major adverse cardiac events (MACE) events were infrequent, with 2 in each arm of the planned invasive group and 1 in the planned noninvasive cohort (usual care strategy). In the planned invasive stratum, mean costs were 33% lower with CTA and selective FFRCT ($8,127 vs. $12,145 usual care; p < 0.0001); in the planned noninvasive stratum, mean costs did not differ when using an FFRCT cost weight of zero ($3,049 FFRCT vs. $2,579; p = 0.82), but were higher when using an FFRCT cost weight equal to CTA. QOL scores improved overall at 1 year (p < 0.001), with similar improvements in both groups, apart from the 5-item EuroQOL scale scores in the noninvasive stratum (mean change of 0.12 for FFRCT vs. 0.07 for usual care; p = 0.02). |
2 |
| 90. Koo BK, Erglis A, Doh JH, et al. Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. Results from the prospective multicenter DISCOVER-FLOW (Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) study. J Am Coll Cardiol 2011;58:1989-97. |
Experimental-Dx |
103 patients |
To determine the diagnostic performance of a new method for quantifying fractional flow reserve (FFR) with computational fluid dynamics (CFD) applied to coronary computed tomography angiography (CCTA) data in patients with suspected or known coronary artery disease (CAD). |
Fifty-six percent of patients had >/=1 vessel with FFR </=0.80. On a per-vessel basis, the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 84.3%, 87.9%, 82.2%, 73.9%, 92.2%, respectively, for FFR(CT) and were 58.5%, 91.4%, 39.6%, 46.5%, 88.9%, respectively, for CCTA stenosis. The area under the receiver-operator characteristics curve was 0.90 for FFR(CT) and 0.75 for CCTA (p = 0.001). The FFR(CT) and FFR were well correlated (r = 0.717, p < 0.001) with a slight underestimation by FFR(CT) (0.022 +/- 0.116, p = 0.016). |
2 |
| 91. Min JK, Leipsic J, Pencina MJ, et al. Diagnostic accuracy of fractional flow reserve from anatomic CT angiography. Jama 2012;308:1237-45. |
Observational-Dx |
252 stable patients |
To assess the diagnostic performance of FFR(CT) plus CT for diagnosis of hemodynamically significant coronary stenosis. |
Among study participants, 137 (54.4%) had an abnormal FFR determined by ICA. On a per-patient basis, diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of FFR(CT) plus CT were 73% (95% CI, 67%-78%), 90% (95% CI, 84%-95%), 54% (95% CI, 46%-83%), 67% (95% CI, 60%-74%), and 84% (95% CI, 74%-90%), respectively. Compared with obstructive CAD diagnosed by CT alone (area under the receiver operating characteristic curve [AUC], 0.68; 95% CI, 0.62-0.74), FFR(CT) was associated with improved discrimination (AUC, 0.81; 95% CI, 0.75-0.86; P < .001). |
1 |
| 92. Norgaard BL, Leipsic J, Gaur S, et al. Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: the NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps). J Am Coll Cardiol 2014;63:1145-55. |
Observational-Dx |
254 patients |
To determine the diagnostic performance of noninvasive fractional flow reserve (FFR) derived from standard acquired coronary computed tomography angiography (CTA) datasets (FFR(CT)) for the diagnosis of myocardial ischemia in patients with suspected stable coronary artery disease (CAD). |
The area under the receiver-operating characteristic curve for FFR(CT) was 0.90 (95% confidence interval [CI]: 0.87 to 0.94) versus 0.81 (95% CI: 0.76 to 0.87) for coronary CTA (p = 0.0008). Per-patient sensitivity and specificity (95% CI) to identify myocardial ischemia were 86% (95% CI: 77% to 92%) and 79% (95% CI: 72% to 84%) for FFR(CT) versus 94% (86 to 97) and 34% (95% CI: 27% to 41%) for coronary CTA, and 64% (95% CI: 53% to 74%) and 83% (95% CI: 77% to 88%) for ICA, respectively. In patients (n = 235) with intermediate stenosis (95% CI: 30% to 70%), the diagnostic accuracy of FFR(CT) remained high. |
2 |
| 93. Pontone G, Andreini D, Guaricci AI, et al. Rationale and design of the PERFECTION (comparison between stress cardiac computed tomography PERfusion versus Fractional flow rEserve measured by Computed Tomography angiography In the evaluation of suspected cOroNary artery disease) prospective study. J Cardiovasc Comput Tomogr. 10(4):330-4, 2016 Jul-Aug. |
Review/Other-Dx |
300 subjects |
To compare the diagnostic accuracy of fractional flow reserve calculated by CTA (FFRct) versus stress myocardial computed tomography perfusion (CTP) for the detection of functionally significant CAD, using invasive FFR as the reference standard. |
The primary study endpoint will be the comparison of per-vessel diagnostic accuracy of CTA versus FFRCT versus stress myocardial CTP for the diagnosis of hemodynamically significant stenosis as defined by invasive FFR =0.80. |
4 |
| 94. Laudon DA, Behrenbeck TR, Wood CM, et al. Computed tomographic coronary artery calcium assessment for evaluating chest pain in the emergency department: long-term outcome of a prospective blind study. Mayo Clin Proc. 85(4):314-22, 2010 Apr. |
Observational-Dx |
263 patients |
To determine the long-term outcome of CT quantification of CAC used as a triage tool for patients presenting with chest pain to an ED. |
Of the 263 study patients, 133 (51%) had a CAC score of zero. This absence of CAC correlated strongly with the likelihood of noncardiac chest pain. Among 133 patients with a CAC score of zero, only 1 (<1%) had cardiac chest pain. Conversely, of the 31 patients shown to have cardiac chest pain, 30 (97%) had evidence of CAC on CT. When a CAC cutoff score of 36 was used, as suggested by receiver operating characteristic analysis, sensitivity was 90%; specificity, 85%; PPV, 44%; and NPV, 99%. During long-term follow-up, patients without CAC experienced no cardiac events at 30 days, 1 year, and 5 years. |
2 |
| 95. Chaikriangkrai K, Palamaner Subash Shantha G, Jhun HY, et al. Prognostic Value of Coronary Artery Calcium Score in Acute Chest Pain Patients Without Known Coronary Artery Disease: Systematic Review and Meta-analysis. [Review]. Ann Emerg Med. 68(6):659-670, 2016 12. |
Meta-analysis |
8 studies; 3,556 patients |
To evaluate the prognostic value and accuracy of a zero (normal) coronary artery calcium score (CACS) for identifying patients at acceptable low risk for future cardiovascular events who might be safely discharged home from the emergency department (ED). |
Eight studies evaluated 3,556 patients, with a median follow-up of 10.5 months. Pooled prevalence of zero CACS was 60%. Patients with CACS=0 had a significantly lower risk of cardiovascular events compared with those with CACS greater than 0 (MACEs: relative risk 0.06, 95% confidence interval 0.04 to 0.11, I2=0%; death/myocardial infarction: relative risk 0.19; 95% confidence interval 0.08 to 0.47, I2=0%). The pooled event rates for CACS=0 (MACEs 0.8%/year; death/myocardial infarction 0.5%/year) were significantly lower than for CACS greater than 0 (MACEs 14.6%/year; death/myocardial infarction 3.5%/year). Analysis of summary testing parameters showed a sensitivity of 96%, specificity of 60%, positive likelihood ratio of 2.36, and negative likelihood ratio of 0.07. |
Good |
| 96. Nance JW Jr, Schlett CL, Schoepf UJ, et al. Incremental prognostic value of different components of coronary atherosclerotic plaque at cardiac CT angiography beyond coronary calcification in patients with acute chest pain. Radiology. 264(3):679-90, 2012 Sep. |
Observational-Dx |
458 patients |
To systematically evaluate the incremental predictive value of cardiac computed tomographic (CT) angiography beyond the assessment of coronary artery calcium (CAC) in patients who present with acute chest pain but without evidence of acute coronary syndrome (ACS). |
Of the 458 patients, 70 (15%) experienced a major adverse cardiac event (MACE) (median follow-up, 13 months). Patients with no plaque at cardiac CT angiography remained free of events during the follow-up period, while 11 (5%) of 215 patients with no CAC had MACE. The extent of plaque was the strongest predictor of MACE independent of traditional risk factors (hazard ratio [HR], 151.77 for four or more segments containing plaque as compared with those containing no plaque; P < .001). Patients with mixed plaque were more likely to experience MACE (HR, 86.96; P = .002) than those with exclusively noncalcified plaque (HR, 58.06; P = .005) or exclusively calcified plaque (HR, 32.94; P = .02). |
4 |
| 97. Hecht HS.. Coronary artery calcium scanning: past, present, and future. [Review]. JACC Cardiovasc Imaging. 8(5):579-596, 2015 May. |
Review/Other-Dx |
N/A |
To summarize the data supporting the application of coronary artery calcium (CAC) to the care of the individual patient, discuss the ongoing controversy, and outline directions for future research. |
No results stated in abstract. |
4 |
| 98. Hinzpeter R, Higashigaito K, Morsbach F, et al. Coronary artery calcium scoring for ruling-out acute coronary syndrome in chest pain CT. Am J Emerg Med. 35(10):1565-1567, 2017 Oct. |
Review/Other-Dx |
204 Patients |
To investigate the value of coronary artery calcium (CAC) scoring for quantification of coronary calcifications as part of chest pain CT. |
No abstract available. |
4 |
| 99. Tota-Maharaj R, McEvoy JW, Blaha MJ, Silverman MG, Nasir K, Blumenthal RS. Utility of coronary artery calcium scoring in the evaluation of patients with chest pain. [Review]. Crit. pathw. cardiol.. 11(3):99-106, 2012 Sep. |
Review/Other-Dx |
N/A |
To discuss the review of articles investigating the utility of: (1) CAC scoring in elective patients with indeterminate chest pain symptoms, (2) CAC as a "gatekeeper" in the triage of patients presenting to the emergency department (ED) with chest pain, and (3) the cost-effectiveness of the use of CAC scoring in the ED |
In our pooled analysis, the presence of any CAC resulted in a high sensitivity (range 70%-100%) for predicting the presence of obstructive coronary disease among symptomatic patients subsequently referred for coronary angiography. More importantly, a CAC score of 0 in low- and intermediate-risk ED populations with chest pain had a high negative predictive value (99.4%) for CHD events over an average follow-up of 21 months. CAC scoring also seems cost-effective in this population. Although further research is needed, carefully selected ED patients with a normal electrocardiogram, normal cardiac biomarkers, and CAC = 0 may be considered for early discharge without further testing. |
4 |
| 100. Yerramasu A, Lahiri A, Venuraju S, et al. Diagnostic role of coronary calcium scoring in the rapid access chest pain clinic: prospective evaluation of NICE guidance. Eur Heart J Cardiovasc Imaging. 15(8):886-92, 2014 Aug. |
Observational-Dx |
300 patients |
To prospectively examine the value of coronary artery calcium (CAC) imaging by unenhanced computed X-ray tomography (CT), as an initial diagnostic test for patients with stable chest pain symptoms but a low likelihood of CAD, in a rapid access chest pain clinic (RACPC). |
The mean patient age was 60.6 (SD 9.6) years and 48% were males. Obstructive CAD was found in 56 (19%) patients, of whom 42 (14%) underwent revascularization. CAC was zero in 131 (44%) patients, of whom two (1.5%) had obstructive CAD and one (0.8%) underwent revascularization. The sensitivity, specificity, negative predictive value, and positive predictive value of CAC >/= 1 for detection of obstructive CAD were 96, 53, 32, and 98%, respectively. None of the 57 patients with low pre-test probability of CAD and zero CAC had obstructive CAD or suffered a cardiovascular event during the follow-up. |
3 |
| 101. Watanabe T, Furuse Y, Ohta Y, Kato M, Ogawa T, Yamamoto K. The Effectiveness of Non-ECG-Gated Contrast-Enhanced Computed Tomography for the Diagnosis of Non-ST Segment Elevation Acute Coronary Syndrome. International Heart Journal. 57(5):558-64, 2016 Sep 28. |
Observational-Dx |
23 Patients |
To investigate the usefulness of non-ECG-gated CE-CT to diagnose NSTE-ACS in patients with acute-onset chest pain. |
The kappa value of the 5-point confidence scaling of EDs between the two readers was only 0.43. However, the identification of ED+ images (definitely and probably present) was highly consistent (kappa = 0.83). Final diagnosis and clinical characteristics: Of the 23 patients who underwent non-ECG-gated CE CT, 13 were diagnosed with NSTE-ACS, including NSTEMI and UAP, and 10 were diagnosed with other conditions. Twelve of the 13 NSTE-ACS patients showed a normal CK level on initial testing. Although standard examinations such as ECG and UCG were performed, NSTE-ACS patients in this study were not diagnosed at first. These 12 patients were finally diagnosed with NSTEMI and the remaining patient was diagnosed with UAP. Apart from the incidence of smoking and the peak CK level, there were no significant differences between the two groups. Diagnostic accuracy of non-ECG-gated CE-CT: Eleven (84.6%) of the 13 NSTE-ACS patients were ED+ by each reader. One patient with UAP was classified as ED- by each reader. Eleven of the 12 (91.6%) patients with NSTEMI were classified ED+ by each reader. The sensitivity, specificity, positive predictive value, and negative predictive value of EDs on non-ECG-gated CE-CT to diagnose NSTE-ACS were 84.6%, 90%, 91.7%, and 81.8%, respectively, for reader 1, and 84.6%, 90%, 91.7%, and 81.8%, respectively, for reader 2. Furthermore, the sensitivity, specificity, positive predictive value, and negative predictive value of EDs on non- ECG-gated CE-CT were 91.7%, 90.9%, 91.7%, and 90.7%, respectively, for the diagnosis of NSTEMI (ie, excluding the patient with UAP; Table V). Receiver operating characteristic (ROC) curves confirmed the high sensitivity and specificity of EDs on non-ECG-gated CE-CT to diagnose NSTE-ACS with areas under the ROC curve of 0.94 for reader 1 and 0.89 for reader 2 (Figure 3A, B). For the diagnosis of NSTEMI, areas under the ROC curve were 0.99 for reader 1 and 0.94 for reader 2. |
3 |
| 102. Yamazaki M, Higuchi T, Shimokoshi T, et al. Acute coronary syndrome: evaluation of detection capability using non-electrocardiogram-gated parenchymal phase CT imaging. Jpn J Radiol. 34(5):331-8, 2016 May. |
Experimental-Dx |
47 Patients |
To evaluate the capability to detect acute coronary syndrome (ACS) by using non-electrocardiogram-gated parenchymal phase CT imaging. |
MPD was detected in 29 of 32 ACSs. The sensitivity, specificity, and positive and negative predictive values were 91 % (29/32), 93 % (14/15), 97 % (29/30), and 82 % (14/17), respectively. The sensitivities of ST- and non-ST-elevation ACSs were 89 % (16/18) and 93 % (13/14), respectively, without significant difference (P > 0.99). Of the CT-detectable ACS, non-ST-elevation on the electrocardiogram and a normal creatine kinase-myocardial band were observed in 41 % (12/29) and 24 % (7/29), respectively. |
4 |
| 103. Yoo SM, Chun EJ, Lee HY, Min D, White CS. Computed Tomography Diagnosis of Nonspecific Acute Chest Pain in the Emergency Department: From Typical Acute Coronary Syndrome to Various Unusual Mimics. [Review]. J Thorac Imaging. 32(1):26-35, 2017 Jan. |
Review/Other-Dx |
N/A |
To present an overview of how to choose an appropriate CT protocol in patients with nonspecific acute chest pain and to provide specific CT findings of ACS and various mimics of ACS. |
No results stated in abstract. |
4 |
| 104. Kanza RE, Allard C, Berube M. Cardiac findings on non-gated chest computed tomography: A clinical and pictorial review. [Review]. Eur J Radiol. 85(2):435-51, 2016 Feb. |
Review/Other-Dx |
N/A |
To 1.) review the normal cardiac anatomy in non-gated chest CT and to propose a stepwise approach to assess the heart for a systematic evaluation of the heart structures during the interpretation of non-cardiac, non-gated chest CT; and 2.) to describe common and less common cardiac abnormalities encountered on routine (non-ECG gated) thoracic CT scans, ranging from simple curiosity to benign, malignant, or even life threatening discoveries. |
No results stated in abstract. |
4 |
| 105. Kajander S, Joutsiniemi E, Saraste M, et al. Cardiac positron emission tomography/computed tomography imaging accurately detects anatomically and functionally significant coronary artery disease. Circulation. 122(6):603-13, 2010 Aug 10. |
Observational-Dx |
107 Patients |
To evaluate the accuracy of PET/CT imaging in the evaluation of CAD. |
Although PET and CT angiography alone both demonstrated 97% negative predictive value, CT angiography alone was suboptimal in assessing the severity of stenosis (positive predictive value, 81%). Perfusion imaging alone could not always separate microvascular disease from epicardial stenoses, but hybrid PET/CT significantly improved this accuracy to 98%. The radiation dose of the combined PET and CT protocols was 9.3 mSv (86 patients) with prospective triggering and 21.8 mSv (21 patients) with spiral CT. |
1 |
| 106. Nandalur KR, Dwamena BA, Choudhri AF, Nandalur SR, Reddy P, Carlos RC. Diagnostic performance of positron emission tomography in the detection of coronary artery disease: a meta-analysis. Acad Radiol. 15(4):444-51, 2008 Apr. |
Meta-analysis |
19 Studies |
To conduct an evidence-based evaluation of PET in the diagnosis of coronary artery disease (CAD). |
Nineteen studies (1442 patients) met the inclusion criteria. On a patient level, PET demonstrated a sensitivity of 0.92 (95% confidence interval [CI]: 0.90-0.94) and specificity of 0.85 (CI: 0.79-0.90), with a positive likelihood ratio (LR+) of 6.2 (CI: 3.3-11.8) and negative likelihood ratio (LR-) of 0.11 (CI: 0.08-0.14). On a coronary territory level (n = 1130), PET showed a sensitivity of 0.81 (CI: 0.77-0.84) and specificity of 0.87 (CI: 0.84-0.90), with an LR+ of 5.9 (CI: 4.5-7.9) and an LR- of 0.19 (CI: 0.09-0.38). |
Good |
| 107. Groves AM, Speechly-Dick ME, Kayani I, et al. First experience of combined cardiac PET/64-detector CT angiography with invasive angiographic validation. Eur J Nucl Med Mol Imaging. 36(12):2027-33, 2009 Dec. |
Observational-Dx |
33 Patients |
To evaluate the performance of combined cardiac PET/64-detector CT angiography. |
CT angiography (without PET data) was concordant with invasive angiography in 31/33 patients and at a patient level, the sensitivity in detecting significant coronary artery lesions was 100%, the specificity was 82%, the PPV was 92% and the negative predictive value (NPV) was 100%. Using combined PET/CT angiography the findings were concordant with invasive angiography in 32/33 patients and at a patient level, the sensitivity was 96%, the specificity was 100%, the PPV was 100% and the NPV was 91%. |
2 |
| 108. Namdar M, Hany TF, Koepfli P, et al. Integrated PET/CT for the assessment of coronary artery disease: a feasibility study. J Nucl Med 2005;46:930-5. |
Observational-Dx |
25 patients |
To evaluate if the combination of PET/CT and contrast-enhanced CTA provides comprehensive information of CAD that allows accurate decisions on whether to treat with revascularization or conservatively. |
Of the 100 coronary artery segments (left main, left anterior descending, left circumflex, and right in 25 patients), 7 (in 5 patients) were considered impossible to evaluate by CT because of rapid vessel movement but were correctly categorized by PET alone. In the remaining 93 segments, the sensitivity and specificity of PET/CT versus PET plus coronary angiography were 90% and 98%, respectively. Positive and negative predictive values were 82% and 99%, and accuracy was 97%. |
3 |
| 109. Jaarsma C, Leiner T, Bekkers SC, et al. Diagnostic performance of noninvasive myocardial perfusion imaging using single-photon emission computed tomography, cardiac magnetic resonance, and positron emission tomography imaging for the detection of obstructive coronary artery disease: a meta-analysis. J Am Coll Cardiol. 2012;59(19):1719-1728. |
Meta-analysis |
166 articles |
To determine the diagnostic accuracy of the 3 most commonly used noninvasive myocardial perfusion imaging modalities, single-photon emission computed tomography (SPECT), cardiac magnetic resonance (CMR), and positron emission tomography (PET) perfusion imaging for the diagnosis of obstructive coronary artery disease (CAD). |
Of the 3,635 citations, 166 articles (n = 17,901) met the inclusion criteria: 114 SPECT, 37 CMR, and 15 PET articles. There were not enough publications on other perfusion techniques such as perfusion echocardiography and computed tomography to include these modalities into the study. The patient-based analysis per imaging modality demonstrated a pooled sensitivity of 88% (95% confidence interval [CI]: 88% to 89%), 89% (95% CI: 88% to 91%), and 84% (95% CI: 81% to 87%) for SPECT, CMR, and PET, respectively; with a pooled specificity of 61% (95% CI: 59% to 62%), 76% (95% CI: 73% to 78%), and 81% (95% CI: 74% to 87%). This resulted in a pooled diagnostic odds ratio (DOR) of 15.31 (95% CI: 12.66 to 18.52; I(2) 63.6%), 26.42 (95% CI: 17.69 to 39.47; I(2) 58.3%), and 36.47 (95% CI: 21.48 to 61.92; I(2) 0%). Most of the evaluated test and study characteristics did not affect the ranking of diagnostic performances. |
M |
| 110. Lerakis S, McLean DS, Anadiotis AV, et al. Prognostic value of adenosine stress cardiovascular magnetic resonance in patients with low-risk chest pain. J Cardiovasc Magn Reson. 2009; 11:37. |
Observational-Dx |
103 patients |
To evaluate the negative prognostic value of adenosine stress-CMR among low-risk acute chest pain patients. |
In 14 patients (13.6%), adenosine stress-CMR was positive. The remaining 89 patients (86.4%), who had negative adenosine stress-CMR, were discharged. No patient with negative adenosine stress-CMR reached the primary end-point during follow-up. The NPV of adenosine stress-CMR was 100%. |
4 |
| 111. Vogel-Claussen J, Skrok J, Dombroski D, et al. Comprehensive adenosine stress perfusion MRI defines the etiology of chest pain in the emergency room: Comparison with nuclear stress test. J Magn Reson Imaging. 2009; 30(4):753-762. |
Observational-Dx |
31 patients |
To compare standard of care nuclear SPECT imaging with CMR for ED patients with chest pain and intermediate probability for CAD. |
Of 27 patients, 8 (30%) showed subendocardial hypoperfusion on CMR that was not detected on SPECT. These patients had a higher rate of diabetes (P=0.01) and hypertension (P=0.01) and a lower global myocardial perfusion reserve (P=0.01) compared with patients with a normal CMR (n=10). Patients with subendocardial hypoperfusion had more risk factors for cardiovascular disease (mean 4.4) compared with patients with a normal CMR (mean 2.5; P=0.005). During the follow-up period, patients with subendocardial hypoperfusion on stress MRI were more likely to return to the ED with chest pain compared with patients who had a normal CMR (P=0.02). Four patients did not finish the MRI examination due to claustrophobia. |
2 |
| 112. Ahmad IG, Abdulla RK, Klem I, et al. Comparison of stress cardiovascular magnetic resonance imaging (CMR) with stress nuclear perfusion for the diagnosis of coronary artery disease. J Nucl Cardiol. 23(2):287-97, 2016 Apr. |
Observational-Dx |
87 patients |
To assess the diagnostic performance of stress cardiac magnetic resonance (stress CMR) vs stress single-photon emission computed tomography (SPECT) in patients presenting to the emergency department (ED) with chest pain. |
Thirty-seven patients were referred for coronary angiography; 29 due to a positive stress test and eight patients for persistent chest pain despite two negative stress tests. There were 22 patients who had significant CAD (=50%). The remaining patients were followed for 2.6 ± 1.1 years. At the conclusion of the follow-up period, there were four clinical events. The sensitivity, specificity, and diagnostic accuracy of CMR are 85%, 93%, and 89%, respectively. The sensitivity, specificity, and diagnostic accuracy of stress SPECT are 84%, 91%, and 88%, respectively. |
2 |
| 113. Macwar RR, Williams BA, Shirani J. Prognostic value of adenosine cardiac magnetic resonance imaging in patients presenting with chest pain. Am J Cardiol. 112(1):46-50, 2013 Jul 01. |
Review/Other-Dx |
626 patients |
To discuss the review of the clinical characteristics of Adenosine cardiac magnetic resonance imaging (AS-CMR) findings |
The AS-CMR findings were normal in 264, ischemic in 201, and scar in 240 patients. No cardiac death occurred in the normal AS-CMR group. Among the ischemic and scar groups, 7.2% and 8.3% experienced an event, respectively. On univariate analysis, ischemia (hazard ratio 5.3, 95% confidence interval 2.5 to 11.5, p <0.001) and the presence of scar (hazard ratio 5.7, 95% confidence interval 2.6 to 12.4, p <0.001) were independent predictors of all cardiac events. Multivariate Cox regression analysis for MACE identified the presence of ischemia (hazard ratio 2.8, 95% confidence interval 1.2 to 6.2, p [ 0.01) and scarring (hazard ratio 2.9, 95% confidence interval 1.3 to 6.6, p [ 0.01) as the strongest independent factors. The annual event rate for hard events was 0% in the normal, 1.7% in the scar, and 1.5% in the ischemia group. For the MACE end points, the rate was 0.5% in the normal, 2.4% in the scar, and 2.6% in the ischemia group. In conclusion, in the present, single-center cohort with chest pain, normal AS-CMR findings conferred very low risk (<1% annually) of MACE. However, the findings of ischemia or scar were a significant and independent predictor of hard events and MACE. |
4 |
| 114. Miller CD, Case LD, Little WC, et al. Stress CMR reduces revascularization, hospital readmission, and recurrent cardiac testing in intermediate-risk patients with acute chest pain. JACC Cardiovasc Imaging. 6(7):785-94, 2013 Jul. |
Experimental-Dx |
105 patients |
To determine the effect of stress CMR imaging in an observation unit on revascularization, hospital readmission, and recurrent cardiac testing in intermediate-risk patients with possible ACS. |
Index hospital admission was avoided in 85% of the observation unit CMR participants. The primary outcome occurred in 20 usual care participants (38%) vs 7 observation unit CMR participants (13%) (HR: 3.4; 95% CI: 1.4 to 8.0, P=0.006). The observation unit CMR group experienced significant reductions in all components: revascularizations (15% vs 2%, P=0.03), hospital readmissions (23% vs 8%, P=0.03), and recurrent cardiac testing (17% vs 4%, P=0.03). Median length of stay was 26 hours (interquartile range: 23 to 45 hours) in the usual care group and 21 hours (interquartile range: 15 to 25 hours) in the observation unit CMR group (P<0.001). ACS after discharge occurred in 3 usual care participants (6%) and no observation unit CMR participants. |
2 |
| 115. Charoenpanichkit C, Hundley WG. The 20 year evolution of dobutamine stress cardiovascular magnetic resonance. [Review]. J Cardiovasc Magn Reson. 12:59, 2010 Oct 26. |
Review/Other-Dx |
N/A |
To review the performance of dobutamine stress CMR and describe the clinical utility of this technique for managing patients with known or suspected CAD. In addition, recent innovations are described that may extend principles learned from dobutamine stress CMR into exercise stress CMR. |
No results stated in abstract. |
4 |
| 116. Korosoglou G, Elhmidi Y, Steen H, et al. Prognostic value of high-dose dobutamine stress magnetic resonance imaging in 1,493 consecutive patients: assessment of myocardial wall motion and perfusion. J Am Coll Cardiol. 2010;56(15):1225-1234. |
Observational-Dx |
1,493 consecutive patients |
To determine the prognostic value of wall motion and perfusion assessment during high-dose dobutamine stress cardiac MRI in a large patient cohort. |
53 hard events, including 14 cardiac deaths and 39 nonfatal infarctions, occurred during the follow-up period, whereas 85 patients underwent "late" revascularization. Using multivariable regression analysis, an abnormal result for wall motion or perfusion during stress yielded the strongest independent prognostic value for both hard events and late revascularization, clearly surpassing that of clinical and baseline MR parameters (for wall motion: adjusted HR of 5.9 [95% CI: 2.5 to 13.6] for hard events and of 3.1 [95% CI: 1.7 to 5.6] for late revascularization, and for perfusion: adjusted HR of 5.4 [95% CI: 2.3 to 12.9] for hard events and of 6.2 [95% CI: 3.3 to 11.3] for late revascularization, P<0.001 for all). |
3 |
| 117. Bodi V, Sanchis J, Lopez-Lereu MP, et al. Prognostic value of dipyridamole stress cardiovascular magnetic resonance imaging in patients with known or suspected coronary artery disease. J Am Coll Cardiol. 50(12):1174-9, 2007 Sep 18. |
Observational-Dx |
420 Patients |
To evaluate the prognostic value of dipyridamole stress cardiovascular magnetic resonance imaging (CMR) in patients with chest pain and known or suspected coronary artery disease. |
During a median follow-up of 420 days, 41 major adverse cardiac events (MACE), including 9 cardiac deaths, 14 nonfatal myocardial infarctions, and 18 readmissions for unstable angina with documented abnormal angiography, were documented. The MACE were more frequent in patients with significant (>1 segment) AWM-rest (22% vs. 5%), AWM-D (21% vs. 4%), perfusion deficit (17% vs. 5%), and delayed enhancement (20% vs. 6%; p <0.0001 in all cases). In a multivariate analysis adjusted for baseline characteristics, the extent of AWM-D was independently related to MACE (hazard ratio [HR] 1.15 [95% confidence interval (CI) 1.06 to 1.24] per segment; p = 0.0006) and to major events (cardiac death or nonfatal myocardial infarction; HR 1.15 [95% CI 1.05 to 1.26] per segment; p = 0.002). |
3 |
| 118. Bodi V, Sanchis J, Lopez-Lereu MP, et al. Prognostic and therapeutic implications of dipyridamole stress cardiovascular magnetic resonance on the basis of the ischaemic cascade. Heart. 95(1):49-55, 2009 Jan. |
Observational-Dx |
601 Patients |
To determine the prognostic and therapeutic implications of stress perfusion cardiovascular magnetic resonance (CMR) on the basis of the ischaemic cascade. |
During a median follow-up of 553 days, 69 major adverse cardiac events (MACE), including 21 cardiac deaths, 14 non-fatal myocardial infarctions and 34 admissions for unstable angina with documented abnormal angiography were detected. In non-revascularised patients (n = 499), the MACE rate was 4% (14/340) in C1, 20% (26/128) in C2 and 39% (12/31) in C3 (adjusted p value = 0.004 vs C2 and <0.001 vs C1). CMR-related revascularisation had neutral effects in C2 (20% vs 19%, 1.1 (0.5 to 2.4), p = 0.7) but independently reduced the risk of MACE in C3 (39% vs 11%, 0.2 (0.1 to 0.7), p = 0.01). |
4 |
| 119. Greenwood JP, Maredia N, Younger JF, et al. Cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary heart disease (CE-MARC): a prospective trial. Lancet. 2012;379(9814):453-460. |
Observational-Dx |
752 patients |
Prospective study to establish the diagnostic accuracy of a multiparametric cardiovascular MR protocol with x-ray coronary angiography as the reference standard and to compare cardiovascular MR with SPECT, in patients with suspected coronary heart disease. |
Of the 752 patients, 39% had significant CHD as identified by x-ray angiography. For multiparametric cardiovascular MR the sensitivity was 86.5% (95% CI, 81.8%-90.1%), specificity 83.4% (79.5%-86.7%), PPV 77.2%, (72.1%-81.6%) and NPV 90.5% (87.1%-93.0%). The sensitivity of SPECT was 66.5% (95% CI, 60.4%-72.1%), specificity 82.6% (78.5%-86.1%), PPV 71.4% (65.3%-76.9%), and NPV 79.1% (74.8%-82.8%). The sensitivity and NPV of cardiovascular MR and SPECT differed significantly (P<0.0001 for both) but specificity and PPV did not (P=0.916 and P=0.061, respectively). Cardiovascular MR had high diagnostic accuracy in coronary heart disease and superiority over SPECT. It should be adopted more widely than at present for the investigation of coronary heart disease. |
3 |
| 120. Schwitter J, Wacker CM, van Rossum AC, et al. MR-IMPACT: comparison of perfusion-cardiac magnetic resonance with single-photon emission computed tomography for the detection of coronary artery disease in a multicentre, multivendor, randomized trial. Eur Heart J. 29(4):480-9, 2008 Feb. |
Experimental-Dx |
241 Patients |
To determine in a multicentre, multivendor trial the diagnostic performance for perfusion-cardiac magnetic resonance (perfusion-CMR) in comparison with coronary X-ray angiography (CXA) and single-photon emission computed tomography (SPECT). |
Perfusion-CMR at the optimal CM dose (0.1 mmol/kg) had similar performance as SPECT, if only the SPECT studies of the 42 patients with this dose were considered [area under ROC curve (AUC): 0.86 +/- 0.06 vs. 0.75 +/- 0.09 for SPECT, P = 0.12]; however, diagnostic performance of perfusion-CMR was better vs. the entire SPECT population (AUC: 0.67 +/- 0.05, n = 212, P = 0.013). |
2 |
| 121. Hussain ST, Paul M, Plein S, et al. Design and rationale of the MR-INFORM study: stress perfusion cardiovascular magnetic resonance imaging to guide the management of patients with stable coronary artery disease. J Cardiovasc Magn Reson. 14:65, 2012 Sep 19. |
Review/Other-Dx |
N/A |
To establish whether guiding the management of patients with a moderate to high risk of coronary artery disease by cardiovascular magnetic resonance (CMR) perfusion is noninferior to guiding the management of these patients by invasive angiography and fractional flow reserve (FFR). |
No results stated in abstract. |
4 |
| 122. Kwong RY, Schussheim AE, Rekhraj S, et al. Detecting acute coronary syndrome in the emergency department with cardiac magnetic resonance imaging. Circulation. 2003;107(4):531-537. |
Observational-Dx |
161 patients |
To explore whether cardiac MRI at rest can effectively assess possible or probable ACS with a combined examination of regional contractile function, perfusion, and viability. |
The sensitivity and specificity, respectively, for detecting acute coronary syndrome were 84% and 85% by MRI, 80% and 61% by an abnormal ECG, 16% and 95% for strict ECG criteria for ischemia (ST depression or T-wave inversion), 40% and 97% for peak troponin-I, and 48% and 85% for a TIMI risk score > or =3. The MRI was more sensitive than strict ECG criteria for ischemia (P<0.001), peak troponin-I (P<0.001), and the TIMI risk score (P=0.004), and MRI was more specific than an abnormal ECG (P<0.001). Multivariate logistic regression analysis showed MRI was the strongest predictor of acute coronary syndrome and added diagnostic value over clinical parameters (P<0.001). |
2 |
| 123. Plein S, Greenwood JP, Ridgway JP, Cranny G, Ball SG, Sivananthan MU. Assessment of non-ST-segment elevation acute coronary syndromes with cardiac magnetic resonance imaging. J Am Coll Cardiol. 44(11):2173-81, 2004 Dec 07. |
Observational-Dx |
68 Patients |
To determine: 1) if the presence of significant coronary stenosis in patients presenting with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) can be predicted by cardiac magnetic resonance (CMR) imaging; and 2) if the analysis of several CMR methods improves its diagnostic yield compared with analysis of individual methods. |
Comprehensive CMR analysis yielded a sensitivity of 96% and a specificity of 83% to predict the presence of significant coronary stenosis and was more accurate than analysis of any individual CMR method; CMR was significantly more sensitive and accurate than the Thrombolysis In Myocardial Infarction risk score (p < 0.001). |
2 |
| 124. Cury RC, Shash K, Nagurney JT, et al. Cardiac magnetic resonance with T2-weighted imaging improves detection of patients with acute coronary syndrome in the emergency department. Circulation. 2008;118(8):837-844. |
Observational-Dx |
62 patients |
To evaluate a CMR protocol that includes T2-weighted imaging and assessment of left ventricular wall thickness in detecting patients with ACS in the emergency department. |
Among 62 patients, 13 developed ACS during the index hospitalization. The mean CMR time was 32 +/- 8 minutes. The new CMR protocol (with the addition of T2-weighted and left ventricular wall thickness) increased the specificity, PPV, and overall accuracy from 84% to 96%, 55% to 85%, and 84% to 93%, respectively, compared with the conventional CMR protocol (cine, perfusion, and delayed-enhancement MRI). Moreover, in a logistic regression analysis that contained information on clinical risk assessment (c-statistic=0.695) and traditional cardiac risk factors (c-statistic=0.771), the new CMR protocol significantly improved the c-statistic to 0.958 (P<0.0001). |
2 |
| 125. Raman SV, Simonetti OP, Winner MW 3rd, et al. Cardiac magnetic resonance with edema imaging identifies myocardium at risk and predicts worse outcome in patients with non-ST-segment elevation acute coronary syndrome. J Am Coll Cardiol. 55(22):2480-8, 2010 Jun 01. |
Review/Other-Dx |
100 Patients |
To define the prevalence and significance of myocardial edema in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). |
Of 88 adequate CMR studies, 57 (64.8%) showed myocardial edema. Obstructive CAD requiring revascularization was present in 87.7% of edema-positive patients versus 25.8% of edema-negative patients (p < 0.001). By multiple logistic regression analysis after adjusting for late gadolinium enhancement, perfusion, and wall motion scores, TIMI risk score was not predictive of obstructive CAD. Conversely, an increase in T2 score by 1 U increased the odds of subsequent coronary revascularization by 5.70 times (95% confidence interval: 2.38 to 13.62, p < 0.001). Adjusting for peak troponin-I, patients with edema showed a higher hazard of a cardiovascular event or death within 6 months after NSTE-ACS compared with those without edema (hazard ratio: 4.47, 95% confidence interval: 1.00 to 20.03; p = 0.050). |
4 |
| 126. Lockie T, Nagel E, Redwood S, Plein S. Use of cardiovascular magnetic resonance imaging in acute coronary syndromes. [Review] [104 refs]. Circulation. 119(12):1671-81, 2009 Mar 31. |
Review/Other-Dx |
N/A |
To present the current evidence for cardiovascular magnetic resonance (CMR) in acute coronary syndromes (ACS) and give an outlook of future developments. |
N/A |
4 |
| 127. Pufulete M, Brierley RC, Bucciarelli-Ducci C, et al. Formal consensus to identify clinically important changes in management resulting from the use of cardiovascular magnetic resonance (CMR) in patients who activate the primary percutaneous coronary intervention (PPCI) pathway. [Review]. BMJ Open. 7(6):e014627, 2017 Jun 22. |
Review/Other-Dx |
37 Draft Statements |
To define important changes in management arising from the use of cardiovascular magnetic resonance (CMR) in patients who activate the primary percutaneous coronary intervention (PPCI) pathway. |
Thirty-seven draft statements describing changes in management following CMR were generated; these were condensed into 12 statements and reviewed through the formal consensus process. Three of 12 statements were classified in consensus in the first survey; these related to the role of CMR in identifying the cause of out-of-hospital cardiac arrest, providing a definitive diagnosis in patients found to have unobstructed arteries on angiography and identifying patients with left ventricular thrombus. Two additional statements were in consensus in the modified survey, relating to the ability of CMR to identify patients who have a poor prognosis after PPCI and assess ischaemia and viability in patients with multivessel disease. |
4 |
| 128. Dastidar AG, Rodrigues JC, Ahmed N, Baritussio A, Bucciarelli-Ducci C. The Role of Cardiac MRI in Patients with Troponin-Positive Chest Pain and Unobstructed Coronary Arteries. [Review]. Curr. cardiovasc. imaging rep.. 8(8):28, 2015. |
Review/Other-Dx |
N/A |
To review the current evidence on the diagnostic role of cardiac magnetic resonance (CMR) in patients with ACS and unobstructed coronary arteries. We have also highlighted the potential role of CMR as a risk stratification or prognostication tool for this patient population. |
No results stated in abstract. |
4 |
| 129. Pathik B, Raman B, Mohd Amin NH, et al. Troponin-positive chest pain with unobstructed coronary arteries: incremental diagnostic value of cardiovascular magnetic resonance imaging. Eur Heart J Cardiovasc Imaging. 17(10):1146-52, 2016 Oct. |
Observational-Dx |
125 Patients |
To determine the incremental diagnostic value of CMR and the heterogeneity in diagnoses by experienced cardiologists when presented with blinded clinical and investigative data in this population. |
CMR provided a diagnosis in 87% of patients. Consensus panel diagnosis and CMR were concordant in 65/125 (52%) patients. There was an only moderate level of agreement between the three cardiologists (k = 0.47, P < 0.05) and a poor level of agreement between the consensus panel and CMR (k = 0.38, P < 0.05) with the most disagreement seen in patients with AMI diagnosed on CMR. |
3 |
| 130. Dall'Armellina E, Piechnik SK, Ferreira VM, et al. Cardiovascular magnetic resonance by non contrast T1-mapping allows assessment of severity of injury in acute myocardial infarction. J Cardiovasc Magn Reson. 14:15, 2012 Feb 06. |
Observational-Dx |
41 patients |
To investigate-in patients with myocardial infarction (MI)- whether state-of the art pre-contrast T1-mapping (1) detects acute myocardial injury, (2) allows for quantification of the severity of damage when compared to standard techniques such as LGE and T2W, and (3) has the ability to predict long term functional recovery. |
We found that the variability of T1 measurements was significantly lower compared to T2W and that, while the diagnostic performance of acute T1-mapping for detecting myocardial injury was at least as good as that of T2W-CMR in STEMI patients, it was superior to T2W imaging in NSTEMI. There was a significant relationship between the segmental damaged fraction assessed by either by LGE or T2W, and mean segmental T1 values (P < 0.01). The index of salvaged myocardium derived by acute T1-mapping and 6M LGE was not different to the one derived from T2W (P = 0.88). Furthermore, the likelihood of improvement of segmental function at 6M decreased progressively as acute T1 values increased (P < 0.0004). |
3 |
| 131. Saremi F.. Cardiac MR Imaging in Acute Coronary Syndrome: Application and Image Interpretation. [Review]. Radiology. 282(1):17-32, 2017 Jan. |
Review/Other-Dx |
N/A |
To introduce a brief explanation of the pathophysiology, classification, and treatment options for patients with ACS.To review indications of cardiac MR imaging in ACS patients and to discuss specific cardiac MR protocol, image interpretation, and potential diagnostic pitfalls. |
No abstract available. |
4 |
| 132. Bluemke DA, Achenbach S, Budoff M, et al. Noninvasive coronary artery imaging: magnetic resonance angiography and multidetector computed tomography angiography: a scientific statement from the american heart association committee on cardiovascular imaging and intervention of the council on cardiovascular radiology and intervention, and the councils on clinical cardiology and cardiovascular disease in the young. Circulation. 2008; 118(5):586-606. |
Review/Other-Dx |
N/A |
Discuss and summarize two noninvasive modalities, MRA and CTA, which may be used for coronary artery evaluation. |
Noninvasive coronary CTA and MRA represent substantial advances that may ultimately be valuable for diagnosis of significant CAD. The chief advantages of coronary CTA compared with MRA are wider availability, higher spatial resolution, and more consistent, shorter examinations with better patient adherence. Advantages associated with coronary MRA are a lack of ionizing radiation and a lack of administration of iodinated contrast material. Both tests are presently suboptimal for patients with atrial fibrillation and other arrhythmias, and image quality may be further reduced by high body mass. |
4 |
| 133. American College of Cardiology Foundation Task Force on Expert Consensus Documents, Hundley WG, Bluemke DA, et al. ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. [Review] [426 refs]. J Am Coll Cardiol. 55(23):2614-62, 2010 Jun 08. |
Review/Other-Dx |
N/A |
To: 1) introduce the basic instrumentation, physics, scan techniques, safety parameters, and contraindications associated with CMR acquisitions; 2) review the use of CMR for assessing patients with cardiovascular disease processes; and 3) unique capabilities of image data generated with CMR are provided relative to other imaging techniques. |
No abstract available. |
4 |
| 134. Kato S, Kitagawa K, Ishida N, et al. Assessment of coronary artery disease using magnetic resonance coronary angiography: a national multicenter trial. J Am Coll Cardiol. 56(12):983-91, 2010 Sep 14. |
Observational-Dx |
138 Patients |
To determine the diagnostic performance of 1.5-T whole-heart coronary magnetic resonance angiography (MRA) in patients with suspected coronary artery disease (CAD). |
Acquisition of whole-heart coronary MRA images was performed in 127 (92%) of 138 patients with an average imaging time of 9.5 ± 3.5 min. The areas under the receiver-operator characteristic curve from MRA images according to vessel- and patient-based analyses were 0.91 (95% confidence interval [CI]: 0.87 to 0.95) and 0.87 (95% CI: 0.81 to 0.93), respectively. The sensitivity, specificity, positive and negative predictive values, and accuracy of MRA according to a patient-based analysis were 88% (49 of 56, 95% CI: 75% to 94%), 72% (51 of 71, 95% CI: 60% to 82%), 71% (49 of 69, 95% CI: 59% to 81%), 88% (51 of 58, 95% CI: 76% to 95%), and 79% (100 of 127, 95% CI: 72% to 86%), respectively. |
2 |
| 135. Dweck MR, Puntman V, Vesey AT, Fayad ZA, Nagel E. MR Imaging of Coronary Arteries and Plaques. [Review]. JACC Cardiovasc Imaging. 9(3):306-16, 2016 Mar. |
Review/Other-Dx |
N/A |
To describe the current status of cardiac magnetic resonance, its capabilities, its limitations, and what will be required in the future to translate this technology into routine clinical practice |
No results stated in abstract. |
4 |
| 136. Dracup K, Alonzo AA, Atkins JM, et al. The physician's role in minimizing prehospital delay in patients at high risk for acute myocardial infarction: recommendations from the National Heart Attack Alert Program. Working Group on Educational Strategies To Prevent Prehospital Delay in Patients at High Risk for Acute Myocardial Infarction. [Review] [61 refs]. Ann Intern Med. 126(8):645-51, 1997 Apr 15. |
Review/Other-Dx |
N/A |
To describe: I) the rationale for targeting patients at high risk for acute myocardial infarction, 2) predictors of patient delay, and 3) recommendations for the education of patients who are at high risk for acute myocardial infarction. |
No results stated in abstract. |
4 |
| 137. Krumholz HM, Bradley EH, Nallamothu BK, et al. A campaign to improve the timeliness of primary percutaneous coronary intervention: Door-to-Balloon: An Alliance for Quality. [Review] [28 refs]. JACC Cardiovasc Interv. 1(1):97-104, 2008 Feb. |
Review/Other-Dx |
N/A |
To describe the rationale and methods for Door-to-Balloon (D2B): An Alliance for Quality, an international effort organized by the American College of Cardiology in partnership with the American Heart Association and 37 other organizations to rapidly translate research about how best to achieve outstanding D2B times for patients with ST-segment elevation myocardial infarction (STEMI) into practice. |
No results stated in abstract. |
4 |
| 138. O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.[Erratum appears in Circulation. 2013 Dec 24;128(25):e481]. Circulation. 127(4):e362-425, 2013 Jan 29. |
Review/Other-Dx |
N/A |
To assist healthcare providers in clinical decision making for the management of ST-elevation myocardial infarction. |
No results stated in abstract. |
4 |
| 139. Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.[Erratum appears in J Am Coll Cardiol. 2014 Dec 23;64(24):2713-4. Dosage error in article text]. J Am Coll Cardiol. 64(24):e139-e228, 2014 Dec 23. |
Review/Other-Dx |
N/A |
To assist healthcare providers in clinical decision making for the management of patients with non–ST-elevation acute coronary syndromes. |
No abstract available. |
4 |
| 140. Korley FK, Jaffe AS. Preparing the United States for high-sensitivity cardiac troponin assays. [Review]. J Am Coll Cardiol. 61(17):1753-8, 2013 Apr 30. |
Review/Other-Dx |
N/A |
To raise a number of important issues regarding the use of high-sensitivity cardiac troponin assays (hs-cTn) that deserve consideration, as a means of educating clinicians and researchers about them. |
No results stated in abstract. |
4 |
| 141. Damman P, Hirsch A, Windhausen F, Tijssen JG, de Winter RJ, ICTUS Investigators. 5-year clinical outcomes in the ICTUS (Invasive versus Conservative Treatment in Unstable coronary Syndromes) trial a randomized comparison of an early invasive versus selective invasive management in patients with non-ST-segment elevation acute coronary syndrome. J Am Coll Cardiol. 55(9):858-64, 2010 Mar 02. |
Experimental-Tx |
1200 Patients |
To present the 5-year clinical outcomes according to treatment strategy with additional risk stratification of the ICTUS (Invasive versus Conservative Treatment in Unstable coronary Syndromes) trial. |
At 5-year follow-up, revascularization rates were 81% in the early invasive and 60% in the selective invasive group. Cumulative death or MI rates were 22.3% and 18.1%, respectively (hazard ratio [HR]: 1.29, 95% confidence interval [CI]: 1.00 to 1.66, p = 0.053). No difference was observed in mortality (HR: 1.13, 95% CI: 0.80 to 1.60, p = 0.49) or MI (HR: 1.24, 95% CI: 0.90 to 1.70, p = 0.20). After risk stratification, no benefit of an early invasive strategy was observed in reducing death or spontaneous MI in any of the risk groups. |
2 |
| 142. Mehta SR, Granger CB, Boden WE, et al. Early versus delayed invasive intervention in acute coronary syndromes. N Engl J Med. 360(21):2165-75, 2009 May 21. |
Experimental-Tx |
3031 Patients |
To determine whether the use of early coronary angiography and intervention in patients with acute coronary syndromes without ST-segment elevation was a superior approach to a delayed strategy of intensive antithrombotic therapy. |
Coronary angiography was performed in 97.6% of patients in the early-intervention group (median time, 14 hours) and in 95.7% of patients in the delayed-intervention group (median time, 50 hours). At 6 months, the primary outcome occurred in 9.6% of patients in the early-intervention group, as compared with 11.3% in the delayed-intervention group (hazard ratio in the early-intervention group, 0.85; 95% confidence interval [CI], 0.68 to 1.06; P=0.15). There was a relative reduction of 28% in the secondary outcome of death, myocardial infarction, or refractory ischemia in the early-intervention group (9.5%), as compared with the delayed-intervention group (12.9%) (hazard ratio, 0.72; 95% CI, 0.58 to 0.89; P=0.003). Prespecified analyses showed that early intervention improved the primary outcome in the third of patients who were at highest risk (hazard ratio, 0.65; 95% CI, 0.48 to 0.89) but not in the two thirds at low-to-intermediate risk (hazard ratio, 1.12; 95% CI, 0.81 to 1.56; P=0.01 for heterogeneity). |
1 |
| 143. O'Donoghue M, Boden WE, Braunwald E, et al. Early invasive vs conservative treatment strategies in women and men with unstable angina and non-ST-segment elevation myocardial infarction: a meta-analysis. JAMA. 300(1):71-80, 2008 Jul 02. |
Meta-analysis |
8 RCTs |
To conduct a meta-analysis of randomized trials to compare the effects of an invasive vs conservative strategy in women and men with NSTE ACS |
Data were combined across 8 trials (3075 women and 7075 men). The odds ratio (OR) for the composite of death, MI, or ACS for invasive vs conservative strategy in women was 0.81 (95% confidence interval [CI], 0.65-1.01; 21.1% vs 25.0%) and in men was 0.73 (95% CI, 0.55-0.98; 21.2% vs 26.3%) without significant heterogeneity between sexes (P for interaction = .26). Among biomarker-positive women, an invasive strategy was associated with a 33% lower odds of death, MI, or ACS (OR, 0.67; 95% CI, 0.50-0.88) and a nonsignificant 23% lower odds of death or MI (OR, 0.77; 95% CI, 0.47-1.25). In contrast, an invasive strategy was not associated with a significant reduction in the triple composite end point in biomarker-negative women (OR, 0.94; 95% CI, 0.61-1.44; P for interaction = .36) and was associated with a nonsignificant 35% higher odds of death or MI (OR, 1.35; 95% CI, 0.78-2.35; P for interaction = .08). Among men, the OR for death, MI, or ACS was 0.56 (95% CI, 0.46-0.67) if biomarker-positive and 0.72 (95% CI, 0.51-1.01) if biomarker-negative (P for interaction = .09). |
Good |
| 144. Kim HW, Farzaneh-Far A, Kim RJ. Cardiovascular magnetic resonance in patients with myocardial infarction: current and emerging applications. [Review] [114 refs]. J Am Coll Cardiol. 55(1):1-16, 2009 Dec 29. |
Review/Other-Dx |
N/A |
To examine the utility of cardiovascular magnetic resonance (CMR) in patients with known or suspected myocardial infarction (MI) with emphasis on the additive clinical information it may provide. Additionally, there has been growing interest in using infarct size measured by CMR as an end point for clinical trials, and we discuss operational and other relevant issues for this application. |
N/A |
4 |
| 145. Emrich T, Emrich K, Abegunewardene N, et al. Cardiac MR enables diagnosis in 90% of patients with acute chest pain, elevated biomarkers and unobstructed coronary arteries. Br J Radiol. 88(1049):20150025, 2015 May. |
Observational-Dx |
125 Patients |
To assess the diagnostic value of cardiac MRI (CMR) in patients with acute chest pain, elevated cardiac enzymes and a negative coronary angiogram. |
MRI revealed a multitude of diagnoses, including ischaemic cardiomyopathy (CM), dilated CM, myocarditis, Takotsubo CM, hypertensive heart disease, hypertrophic CM, cardiac amyloidosis and non-compaction CM. MRI-based diagnoses were the same as the final reference diagnoses in 113/125 patients (90%), with the two diagnoses differing in only 12/125 patients. In two patients, no final diagnosis could be established. |
3 |
| 146. Mahmarian JJ, Shaw LJ, Filipchuk NG, et al. A multinational study to establish the value of early adenosine technetium-99m sestamibi myocardial perfusion imaging in identifying a low-risk group for early hospital discharge after acute myocardial infarction. J Am Coll Cardiol. 48(12):2448-57, 2006 Dec 19. |
Observational-Tx |
728 Patients |
To determine whether gated adenosine Tc-99m sestamibi single-photon emission computed tomography (ADSPECT) could accurately define risk and thereby guide therapeutic decision making in stable survivors of acute myocardial infarction (AMI). |
Total cardiac events/death and reinfarction significantly increased within each INSPIRE risk group from low (5.4%, 1.8%), to intermediate (14%, 9.2%), to high (18.6%, 11.6%) (p < 0.01). Event rates at 1 year were lowest in patients with the smallest perfusion defects but progressively increased when defect size exceeded 20% (p < 0.0001). The perfusion results significantly improved risk stratification beyond that provided by clinical and ejection fraction variables. The low-risk INSPIRE group, comprising one-third of all enrolled patients, had a shorter hospital stay with lower associated costs compared with the higher-risk groups (p < 0.001). |
1 |
| 147. Shaw LJ, Hachamovitch R, Berman DS, et al. The economic consequences of available diagnostic and prognostic strategies for the evaluation of stable angina patients: an observational assessment of the value of precatheterization ischemia. Economics of Noninvasive Diagnosis (END) Multicenter Study Group. J Am Coll Cardiol. 33(3):661-9, 1999 Mar. |
Observational-Tx |
11,372 patients |
To determine observational differences in costs of care by the coronary disease diagnostic test modality. |
Observational comparisons of aggressive as compared with conservative testing strategies reveal that costs of care were higher for direct cardiac catheterization in all clinical risk subsets (range: $2,878 to $4,579), as compared with stress myocardial perfusion imaging plus selective catheterization (range: $2,387 to $3,010, p < 0.0001). Coronary revascularization rates were higher for low, intermediate and high risk direct catheterization patients as compared with the initial stress perfusion imaging cohort (13% to 50%, p < 0.0001); cardiac death or myocardial infarction rates were similar (p > 0.20). |
1 |
| 148. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
