Wednesday, February 20, 2013

Pooled CCTA Outcomes

The state of the art for coronary CT angiograms progressed a great deal in the past year.  Four recent studies, CT-STAT, ACRIN-PA, ROMICAT II, and a fourth by Goldstein et al., have added to our knowledge base regarding the performance characteristics of this test.

Overall, by pooling 3,266 patients from these four trials, a couple new features shake out as statistically significant.  Specifically, patients undergoing CCTA were significantly more likely (6.3% vs 8.4%) to undergo ICA, and then more likely to receive revascularization (2.6% vs. 4.6%).  This adds to what we already knew – CCTA shortens ED length of stay and reduces overall ED costs compared with "usual care".

But, we still don't really know if this test is improving important patient-oriented outcomes.  These intervention numbers are quite low – meaning a great number of patients simply received expensive diagnostic testing, without any sort of treatment.  Then, we don't even know if these revascularizations are improving (or worsening!) outcomes.  Technology keeps blundering forward with its flawed disconnect from rationality – the costs go up and up, but we don't hardly stop to measure whether we're actually doing any good....

"Outcomes After Coronary Computed Tomography Angiography in the Emergency Department"

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