Abstract
Introduction and objectives
Up to 5% patients with acute chest pain present an acute coronary syndrome (ACS). This study aimed to compare peak exercise echocardiography (ExE) and multidetector computed tomography (MCT) in patients referred to a chest pain unit.
Methods
203 patients with ≥1 cardiovascular risk factors, no ischemic ECG changes and negative biomarkers were randomized to ExE (n=103) or MCT (n=100). The endpoints were hard events (cardiovascular death and non-fatal myocardial infarction), combined events (hard events and revascularizations), and combined events plus readmissions during follow-up. Cost of either strategy was also investigated.
Results
Mean age was 64±11 years and 131 patients were male. Hypertension was seen in 71%, hypercholesterolemia in 74%, diabetes mellitus in 28%, and smoking in 21%. Most of the patients had a low TIMI risk score (68% TIMI I and 32% TIMI II). Mean follow-up was 4,7±2,7 years. Invasive angiography due to positive/nonconclusive results was performed in 34 of the patients, 103 submitted to SE and in 27 of the 100 submitted to MCT (33% vs. 27%, p=0.15). A final diagnosis of acute coronary syndrome was achieved in 53 patients (30 [88%] in the ExE group and 23 [85%] in the MCT group, p=0.12). There were no significant differences between groups in hard events (5 [5%] patients in the ExE group and 7 [7%] in the MCT group, p=0,42), combined events (35 patients [34%] in the ExE group and 29 [29%] in the MCT group), and combined events plus readmissions (43 [42%] patients in the ExE group and 41 [41%] in the MCT). The median stay in hospital was 7 (5–10) days in the ExE group and 8 (5–10,25) in the MCT group (p=NS). For patients with negative results by either technique the mean stay was less than 8 hours. There were no differences in the global cost, although it was lower for patients with negative ExE (557 € vs. 706 €, p<0,02) as compared to those with negative TCM.
Conclusions
Both MCT and ExE are equally effective for the stratification of patients with low to moderate probability of ACS admitted to a chest pain unit. The cost was similar with both strategies, although significant lower in ExE when negative studies were compared.
Current Role of Computed Tomography in the Evaluation of Acute Coronary Syndrome
