Initial functional stress testing compared with invasive coronary angiography resulted in no significant difference in 30-day major adverse cardiac events (0% vs. 2.6%, P=0.322).
Cohort (n=118)
Does functional stress testing compared to direct invasive coronary angiography reduce unnecessary procedures without compromising safety in acute chest pain patients with intermediate coronary stenosis on CCTA?
In patients with intermediate coronary stenosis on CCTA, utilizing functional stress testing instead of direct invasive angiography reduces unnecessary catheterizations and revascularizations without compromising 30-day safety.
Tasa de eventos absoluta: 0% vs 2.6%
valor p: p=0.322
INTRODUCTION: The aim of this study was to evaluate the effectiveness of functional testing in comparison to invasive coronary angiography (ICA) among acute chest pain patients whose first diagnostic modality was a coronary computed tomography angiogram (CCTA) and were found to have intermediate coronary stenosis, defined as 50%-70% luminal stenosis. METHODS: We conducted a retrospective review of 4763 acute chest pain patients ≥18 years old who received a CCTA as the initial diagnostic modality. Of these, 118 patients met enrollment criteria and proceeded to either stress test (80/118) or directly to ICA (38/118). The primary outcome was 30-day major adverse cardiac event, consisting of acute myocardial infarction, urgent revascularization, or death. RESULTS: There was no difference in 30-day major adverse cardiac event among patients who underwent initial stress testing versus directly referred to ICA (0% vs. 2.6%, P = 0.322) following CCTA. The rate of revascularization without acute myocardial infarction was significantly higher among those who underwent ICA versus stress test 36.8% vs. 3.8%, P < 0.0001; adjusted odds ratio: 9.6, 95% confidence interval, 1.8-49.6. Patients who underwent ICA had a higher rate of catheterization without revascularization within 30 days of the index admission in comparison to those who underwent initial stress testing (55.3% vs. 12.5%, P < 0.0001; adjusted odds ratio: 26.7, 95% confidence interval, 6.6-109.5). CONCLUSION: Among patients with intermediate coronary stenosis on CCTA, a functional stress test compared with ICA may prevent unnecessary revascularization and improve cardiac catheterization yield without negatively affecting the 30-day patient safety profile.
Bhagat et al. (Wed,) conducted a cohort in Acute chest pain with intermediate coronary stenosis on CCTA (n=118). Functional stress testing vs. Invasive coronary angiography (ICA) was evaluated on 30-day major adverse cardiac event (acute myocardial infarction, urgent revascularization, or death) (p=0.322). Initial functional stress testing compared with invasive coronary angiography resulted in no significant difference in 30-day major adverse cardiac events (0% vs. 2.6%, P=0.322).