Randomized controlled trials of imaging strategies for chest pain
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.
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.
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.