Impact of coronary calcification on clinical management in patients with acute chest pain

Daniel O. Bittner, Thomas Mayrhofer, Fabian Bamberg, Travis R. Hallett, Sumbal Janjua, Daniel Addison, John T. Nagurney, James E. Udelson, Michael T. Lu, Quynh A. Truong, Pamela K. Woodard, Judd E. Hollander, Chadwick Miller, Anna Marie Chang, Harjit Singh, Harold Litt, Udo Hoffmann, Maros Ferencik

    Research output: Contribution to journalArticle

    8 Citations (Scopus)

    Abstract

    Background-Coronary artery calcification (CAC) may impair diagnostic assessment of coronary computed tomography angiography (CTA). We determined whether CAC affects efficiency of coronary CTA in patients with suspected acute coronary syndrome (ACS). Methods and Results-This is a pooled analysis of ACRIN-PA (American College of Radiology Imaging Network- Pennsylvania) 4005 and the ROMICAT-II trial (Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography) comparing an initial coronary CTA strategy to standard of care in acute chest pain patients. In the CTA arms, we investigated appropriateness of downstream testing, cost, and diagnostic yield to identify patients with obstructive coronary artery disease on subsequent invasive coronary angiography across CAC score strata (Agatston score: 0, >0-10, >10-100, >100-400, >400). Out of 1234 patients (mean age 51±8.8 years), 80 (6.5%) had obstructive coronary artery disease (=70% stenosis) and 68 (5.5%) had ACS. Prevalence of obstructive coronary artery disease (1%-64%), ACS (1%-44%), downstream testing (4%-72%), and total (2337-8484 US$) and diagnostic cost (2310-6678 US$) increased across CAC strata (P<0.001). As the increase in testing and cost were lower than the increase of ACS rate in patients with CAC>400, cost to diagnose one ACS was lowest in this group (19 283 US$ versus 464 399 US$) as compared with patients without CAC. The diagnostic yield of invasive coronary angiography was highest in patients with CAC>400 (87% versus 38%). Conclusions-Downstream testing, total, and diagnostic cost increased with increasing CAC, but were found to be appropriate because obstructive coronary artery disease and ACS were more prevalent in patients with high CAC. In patients with acute chest pain undergoing coronary CTA, cost-efficient testing and excellent diagnostic yield can be achieved even with high CAC burden.

    Original languageEnglish (US)
    Article numbere005893
    JournalCirculation: Cardiovascular Imaging
    Volume10
    Issue number5
    DOIs
    StatePublished - May 1 2017

    Fingerprint

    Acute Pain
    Chest Pain
    Coronary Vessels
    Acute Coronary Syndrome
    Coronary Artery Disease
    Costs and Cost Analysis
    Coronary Angiography
    Standard of Care
    Radiology
    Myocardial Ischemia
    Pathologic Constriction
    Myocardial Infarction
    Tomography
    Computed Tomography Angiography

    Keywords

    • Acute chest pain
    • Acute coronary syndrome
    • Coronary artery calcification
    • Coronary CT angiography
    • Coronary stenosis
    • Resource utilization

    ASJC Scopus subject areas

    • Radiology Nuclear Medicine and imaging
    • Cardiology and Cardiovascular Medicine

    Cite this

    Impact of coronary calcification on clinical management in patients with acute chest pain. / Bittner, Daniel O.; Mayrhofer, Thomas; Bamberg, Fabian; Hallett, Travis R.; Janjua, Sumbal; Addison, Daniel; Nagurney, John T.; Udelson, James E.; Lu, Michael T.; Truong, Quynh A.; Woodard, Pamela K.; Hollander, Judd E.; Miller, Chadwick; Chang, Anna Marie; Singh, Harjit; Litt, Harold; Hoffmann, Udo; Ferencik, Maros.

    In: Circulation: Cardiovascular Imaging, Vol. 10, No. 5, e005893, 01.05.2017.

    Research output: Contribution to journalArticle

    Bittner, DO, Mayrhofer, T, Bamberg, F, Hallett, TR, Janjua, S, Addison, D, Nagurney, JT, Udelson, JE, Lu, MT, Truong, QA, Woodard, PK, Hollander, JE, Miller, C, Chang, AM, Singh, H, Litt, H, Hoffmann, U & Ferencik, M 2017, 'Impact of coronary calcification on clinical management in patients with acute chest pain', Circulation: Cardiovascular Imaging, vol. 10, no. 5, e005893. https://doi.org/10.1161/CIRCIMAGING.116.005893
    Bittner, Daniel O. ; Mayrhofer, Thomas ; Bamberg, Fabian ; Hallett, Travis R. ; Janjua, Sumbal ; Addison, Daniel ; Nagurney, John T. ; Udelson, James E. ; Lu, Michael T. ; Truong, Quynh A. ; Woodard, Pamela K. ; Hollander, Judd E. ; Miller, Chadwick ; Chang, Anna Marie ; Singh, Harjit ; Litt, Harold ; Hoffmann, Udo ; Ferencik, Maros. / Impact of coronary calcification on clinical management in patients with acute chest pain. In: Circulation: Cardiovascular Imaging. 2017 ; Vol. 10, No. 5.
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    abstract = "Background-Coronary artery calcification (CAC) may impair diagnostic assessment of coronary computed tomography angiography (CTA). We determined whether CAC affects efficiency of coronary CTA in patients with suspected acute coronary syndrome (ACS). Methods and Results-This is a pooled analysis of ACRIN-PA (American College of Radiology Imaging Network- Pennsylvania) 4005 and the ROMICAT-II trial (Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography) comparing an initial coronary CTA strategy to standard of care in acute chest pain patients. In the CTA arms, we investigated appropriateness of downstream testing, cost, and diagnostic yield to identify patients with obstructive coronary artery disease on subsequent invasive coronary angiography across CAC score strata (Agatston score: 0, >0-10, >10-100, >100-400, >400). Out of 1234 patients (mean age 51±8.8 years), 80 (6.5{\%}) had obstructive coronary artery disease (=70{\%} stenosis) and 68 (5.5{\%}) had ACS. Prevalence of obstructive coronary artery disease (1{\%}-64{\%}), ACS (1{\%}-44{\%}), downstream testing (4{\%}-72{\%}), and total (2337-8484 US$) and diagnostic cost (2310-6678 US$) increased across CAC strata (P<0.001). As the increase in testing and cost were lower than the increase of ACS rate in patients with CAC>400, cost to diagnose one ACS was lowest in this group (19 283 US$ versus 464 399 US$) as compared with patients without CAC. The diagnostic yield of invasive coronary angiography was highest in patients with CAC>400 (87{\%} versus 38{\%}). Conclusions-Downstream testing, total, and diagnostic cost increased with increasing CAC, but were found to be appropriate because obstructive coronary artery disease and ACS were more prevalent in patients with high CAC. In patients with acute chest pain undergoing coronary CTA, cost-efficient testing and excellent diagnostic yield can be achieved even with high CAC burden.",
    keywords = "Acute chest pain, Acute coronary syndrome, Coronary artery calcification, Coronary CT angiography, Coronary stenosis, Resource utilization",
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    T1 - Impact of coronary calcification on clinical management in patients with acute chest pain

    AU - Bittner, Daniel O.

    AU - Mayrhofer, Thomas

    AU - Bamberg, Fabian

    AU - Hallett, Travis R.

    AU - Janjua, Sumbal

    AU - Addison, Daniel

    AU - Nagurney, John T.

    AU - Udelson, James E.

    AU - Lu, Michael T.

    AU - Truong, Quynh A.

    AU - Woodard, Pamela K.

    AU - Hollander, Judd E.

    AU - Miller, Chadwick

    AU - Chang, Anna Marie

    AU - Singh, Harjit

    AU - Litt, Harold

    AU - Hoffmann, Udo

    AU - Ferencik, Maros

    PY - 2017/5/1

    Y1 - 2017/5/1

    N2 - Background-Coronary artery calcification (CAC) may impair diagnostic assessment of coronary computed tomography angiography (CTA). We determined whether CAC affects efficiency of coronary CTA in patients with suspected acute coronary syndrome (ACS). Methods and Results-This is a pooled analysis of ACRIN-PA (American College of Radiology Imaging Network- Pennsylvania) 4005 and the ROMICAT-II trial (Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography) comparing an initial coronary CTA strategy to standard of care in acute chest pain patients. In the CTA arms, we investigated appropriateness of downstream testing, cost, and diagnostic yield to identify patients with obstructive coronary artery disease on subsequent invasive coronary angiography across CAC score strata (Agatston score: 0, >0-10, >10-100, >100-400, >400). Out of 1234 patients (mean age 51±8.8 years), 80 (6.5%) had obstructive coronary artery disease (=70% stenosis) and 68 (5.5%) had ACS. Prevalence of obstructive coronary artery disease (1%-64%), ACS (1%-44%), downstream testing (4%-72%), and total (2337-8484 US$) and diagnostic cost (2310-6678 US$) increased across CAC strata (P<0.001). As the increase in testing and cost were lower than the increase of ACS rate in patients with CAC>400, cost to diagnose one ACS was lowest in this group (19 283 US$ versus 464 399 US$) as compared with patients without CAC. The diagnostic yield of invasive coronary angiography was highest in patients with CAC>400 (87% versus 38%). Conclusions-Downstream testing, total, and diagnostic cost increased with increasing CAC, but were found to be appropriate because obstructive coronary artery disease and ACS were more prevalent in patients with high CAC. In patients with acute chest pain undergoing coronary CTA, cost-efficient testing and excellent diagnostic yield can be achieved even with high CAC burden.

    AB - Background-Coronary artery calcification (CAC) may impair diagnostic assessment of coronary computed tomography angiography (CTA). We determined whether CAC affects efficiency of coronary CTA in patients with suspected acute coronary syndrome (ACS). Methods and Results-This is a pooled analysis of ACRIN-PA (American College of Radiology Imaging Network- Pennsylvania) 4005 and the ROMICAT-II trial (Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography) comparing an initial coronary CTA strategy to standard of care in acute chest pain patients. In the CTA arms, we investigated appropriateness of downstream testing, cost, and diagnostic yield to identify patients with obstructive coronary artery disease on subsequent invasive coronary angiography across CAC score strata (Agatston score: 0, >0-10, >10-100, >100-400, >400). Out of 1234 patients (mean age 51±8.8 years), 80 (6.5%) had obstructive coronary artery disease (=70% stenosis) and 68 (5.5%) had ACS. Prevalence of obstructive coronary artery disease (1%-64%), ACS (1%-44%), downstream testing (4%-72%), and total (2337-8484 US$) and diagnostic cost (2310-6678 US$) increased across CAC strata (P<0.001). As the increase in testing and cost were lower than the increase of ACS rate in patients with CAC>400, cost to diagnose one ACS was lowest in this group (19 283 US$ versus 464 399 US$) as compared with patients without CAC. The diagnostic yield of invasive coronary angiography was highest in patients with CAC>400 (87% versus 38%). Conclusions-Downstream testing, total, and diagnostic cost increased with increasing CAC, but were found to be appropriate because obstructive coronary artery disease and ACS were more prevalent in patients with high CAC. In patients with acute chest pain undergoing coronary CTA, cost-efficient testing and excellent diagnostic yield can be achieved even with high CAC burden.

    KW - Acute chest pain

    KW - Acute coronary syndrome

    KW - Coronary artery calcification

    KW - Coronary CT angiography

    KW - Coronary stenosis

    KW - Resource utilization

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