• James K Min, Sunaina Koduru, Allison M Dunning, Jason H Cole, Jerome L Hines, Dawn Greenwell, Cathie Biga, Gayle Fanning, Troy M LaBounty, Millie Gomez, James M Horowitz, Martin Hadimitzsky, Jorg Hausleiter, Tracy Q Callister, Alan R Rosanski, Leslee J Shaw, Daniel S Berman, and Fay Y Lin.
• Heart Institute, Division of Cardiology, Cedars Sinai Medical Center, Los Angeles, CA, USA.
• J Cardiovasc Comput Tomogr. 2012 Jul 1;6(4):274-83.

BackgroundClinical outcomes and resource utilization after coronary computed tomography angiography (CTA) versus myocardial perfusion single-photon emission CT (MPS) in patients with stable angina and suspected coronary artery disease (CAD) has not been examined.ObjectiveWe determined the near-term clinical effect and resource utilization after cardiac CTA compared with MPS.MethodsWe randomly assigned 180 patients (age, 57.3 ± 9.8 years; 50.6% men) presenting with stable chest pain and suspected CAD at 2 sites to initial diagnostic evaluation by coronary CTA (n = 91) or MPS (n = 89). The primary outcome was near-term angina-specific health status; the secondary outcomes were incident medical and invasive treatments for CAD, CAD health care costs, and estimated radiation dose.ResultsNo patients experienced myocardial infarction or death with 98.3% follow-up at 55 ± 34 days. Both arms experienced comparable improvements in angina-specific health status. Patients who received coronary CTA had increased incident aspirin (22% vs 8%; P = 0.04) and statin (7% vs -3.5%; P = 0.03) use, similar rates of CAD-related hospitalization, invasive coronary angiography, noninvasive cardiac imaging tests, and increased revascularization (8% vs 1%; P = 0.03). Coronary CTA had significantly lower total costs ($781.08 [interquartile range (IQR), $367.80-$4349.48] vs $1214.58 [IQR, $978.02-$1569.40]; P < 0.001) with no difference in induced costs. Coronary CTA had a significantly lower total estimated effective radiation dose (7.4 mSv [IQR, 5.0-14.0 mSv] vs 13.3 mSv [IQR, 13.1-38.0 mSv]; P < 0.0001) with no difference in induced radiation.ConclusionIn a pilot randomized controlled trial, patients with stable CAD undergoing coronary CTA and MPS experience comparable improvements in near-term angina-related quality of life. Compared with MPS, coronary CTA evaluation is associated with more aggressive medical therapy, increased coronary revascularization, lower total costs, and lower effective radiation dose.Copyright © 2012. Published by Elsevier Inc.

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