Comparative Effectiveness and Resource Utilization

Randomized controlled trials of imaging strategies for chest pain

Coronary CT demonstrating severe stenosis of the left
anterior descending coronary artery (arrow).

Our recently completed multicenter randomized controlled trials have established the efficacy of a coronary CT angiography-based diagnostic strategy for chest pain. The ROMICAT II trial (n=1,000) found that a CT for acute chest pain resulted in improved efficiency of clinical decision making. The PROMISE trial (n=10,000) found that a CT diagnostic strategy resulted in similar outcomes to functional testing for stable chest pain. Our current efforts focus on whether coronary plaque morphology can predict which patients are at greatest risk.

Hoffmann U et al, Coronary CT angiography versus standard evaluation in acute chest pain. N Engl J Med 2012;367(4):299-308.

Douglas PD et al. Outcomes of anatomical versus functional testing for coronary artery disease. N Engl J Med 2015;372(14):1291-300.

 

Utilization, cost, and cost effectiveness analysis
Our group has investigated the cost and cost-effectiveness of imaging strategies for chest pain, including the cost incurred by incidental findings. National utilization of cardiovascular imaging services has also been assessed.

Ladapo JA et al. Clinical outcomes and cost-effectiveness of coronary computed tomography angiography in the evaluation of patients with chest pain. J Am Coll Cardiol 2009;54(25):2409-22.

Goehler A et al. Cost-effectiveness of follow-up of pulmonary nodules incidentally detected on cardiac computed tomographic angiography in patients with suspected coronary artery disease. Circulation 2014;130(8):668-75.

Prabhakar AM et al. Medicare utilization of vascular ultrasound from 1998 to 2013. J Am Coll Radiol 2016;13(3):255-64.

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