Devine Patrick J, Villines Todd C, Sullenberger Lance E, Anderson Donald R, Malik Anwar K, Feuerstein Irwin M, Taylor Allen J
Cardiology Service, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA.
J Cardiovasc Comput Tomogr. 2008 Jul-Aug;2(4):214-9. doi: 10.1016/j.jcct.2008.05.002. Epub 2008 May 22.
Evaluating low-risk outpatients with chest pain is a common clinical problem and poses significant demand on clinical resource utilization. Despite the impressive performance characteristics of coronary multislice computed tomography (MSCT) angiography, its implementation in the diagnostic evaluation of outpatient chest pain and its effect on downstream resource utilization remains undefined.
We compared the effect of a strategy that used MSCT with a traditional strategy (pre-MSCT strategy) in which MSCT was not available on clinical downstream resource utilization, defined as the need for further stress testing or cardiac catheterization.
We retrospectively identified 75 patients without known disease who had undergone MSCT angiography for the primary indication of possible angina. The review of clinical vignettes of these 75 patients and completion of surveys assessing diagnostic strategy by two general cardiologists represented the pre-MSCT diagnostic strategy. Survey responses were compared with the number of cardiac catheterizations and stress tests that actually resulted after MSCT angiography (MSCT strategy).
A strategy that used MSCT angiography in the evaluation of patients with possible angina would have significantly reduced the need for further stress testing and cardiac catheterizations (58 vs 11; P < 0.005). Furthermore, this strategy would have resulted in significantly fewer unnecessary cardiac catheterizations (6 vs 23; P < 0.005).
Coronary MSCT angiography can potentially reduce the need for further stress tests or cardiac catheterizations in the evaluation of low- to intermediate-risk patients with possible angina. Prospective studies are needed to validate these findings and to assess the overall cost effectiveness of implementing MSCT early in the outpatient evaluation of angina.
评估低风险胸痛门诊患者是常见的临床问题，对临床资源利用提出了重大需求。尽管冠状动脉多层螺旋计算机断层扫描（MSCT）血管造影具有令人印象深刻的性能特征，但其在门诊胸痛诊断评估中的应用及其对下游资源利用的影响仍不明确。
我们比较了使用MSCT的策略与传统策略（MSCT前策略，即无法使用MSCT）对临床下游资源利用的影响，下游资源利用定义为进一步进行负荷试验或心导管检查的需求。
我们回顾性确定了75例无已知疾病、因可能心绞痛的主要指征接受MSCT血管造影的患者。对这75例患者的临床病例进行回顾，并由两位普通心脏病专家完成评估诊断策略的调查，代表MSCT前诊断策略。将调查结果与MSCT血管造影后实际进行的心导管检查和负荷试验数量（MSCT策略）进行比较。
在评估可能心绞痛患者时使用MSCT血管造影的策略将显著减少进一步进行负荷试验和心导管检查的需求（58次对11次；P<0.005）。此外，该策略将导致不必要的心导管检查显著减少（6次对23次；P<0.005）。
冠状动脉MSCT血管造影在评估低至中度风险的可能心绞痛患者时，可能减少进一步进行负荷试验或心导管检查的需求。需要进行前瞻性研究来验证这些发现，并评估在心绞痛门诊评估早期实施MSCT的总体成本效益。
