The third of the big CT coronary angiography studies from the last year – and, yet again, this is positive for its primary endpoint.
However, that value of that endpoint is another matter – mean length of stay in the hospital. For the CCTA cohort, that mean was 23.2 hours and the “standard evaluation” was 30.8 hours. However, more illuminating – and further favoring CCTA – is that the median CCTA evaluation time was 8.6 hours compared with 26.7 hours in the “standard evaluation” group. Just like in the previous studies, CCTA is faster, and, for some patients, much, much faster.
But, as you can probably gather from that mean/median discrepancy, a substantial cohort in the CCTA group went on to have some pretty extensive downstream testing and prolonged hospital stays. This means, from a costs standpoint, the two strategies eventually even out. No significant safety differences were detected between the two strategies.
Now that we’ve seen the full results of ROMICAT II, CT-STAT, and ACRIN-PA, we have a pretty good idea of what this test does. If you must evaluate these low-risk chest pain patients with imaging of some sort, need to clear them out of your Emergency Department quickly, your cardiology team is excited to take on the false positives, and you’re unconcerned about the downstream harms – then CCTA is the test for you. If the potential harms, the poor specificity, and the non-functional nature of the test concerns you – then no one will fault you for dragging your feet.
The accompanying editorial gets it right – this is still a test looking for the correct application. However, we don’t just need a better test – we need a better consensus for whom we’re simply not going to test.
“Coronary CT Angiography versus Standard Evaluation in Acute Chest Pain”