Economic Outcomes With Anatomical Versus Functional Diagnostic Testing for Coronary Artery Disease

Letters20 December 2016Economic Outcomes With Anatomical Versus Functional Diagnostic Testing for Coronary Artery DiseaseWade H. Martin III, MDWade H. Martin III, MDFrom Washington University School of Medicine and the St. Louis Veterans Administration Healthcare System, St. Louis, Missouri.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L16-0481 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Mark and colleagues' (1) cost analysis of data from PROMISE (PROspective Multicenter Imaging Study for Evaluation of Chest Pain) suggests little or no difference in cost or outcomes with cardiac computed tomography angiography (CTA) versus functional stress testing for assessment of chest pain or other symptoms of coronary artery disease in relatively low-risk patients evaluated in emergency departments. However, this trial and its conclusions have several important caveats.First, whether pharmacologic stress testing legitimately can be termed “functional” is debatable. Truly functional and relevant clinical information, such as exercise capacity; recovery heart rate; and exercise-induced symptoms, dysrhythmias, ...References1. Mark DB, Federspiel JJ, Cowper PA, Anstrom KJ, Hoffmann U, Patel MR, et al; PROMISE Investigators. Economic outcomes with anatomical versus functional diagnostic testing for coronary artery disease. Ann Intern Med. 2016;165:94-102. [PMID: 27214597]. doi:10.7326/M15-2639 LinkGoogle Scholar2. Mark DB, Shaw L, Harrell FE Jr, Hlatky MA, Lee KL, Bengtson JR, et al. Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. N Engl J Med. 1991;325:849-53. [PMID: 1875969] CrossrefMedlineGoogle Scholar3. Cole CR, Blackstone EH, Pashkow FJ, Snader CE, Lauer MS. Heart-rate recovery immediately after exercise as a predictor of mortality. N Engl J Med. 1999;341:1351-7. [PMID: 10536127] CrossrefMedlineGoogle Scholar4. Douglas PS, Hoffmann U. Anatomical versus functional testing for coronary artery disease [Letter]. N Engl J Med. 2015;373:91. [PMID: 26132947] doi:10.1056/NEJMc1505594 CrossrefMedlineGoogle Scholar5. Squires D, Anderson C. U.S. health care from a global perspective: spending, use of services, prices, and health in 13 countries. The Commonwealth Fund. 8 October 2015. Accessed at www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective on 6 June 2016. Google Scholar Author, Article, and Disclosure InformationAffiliations: From Washington University School of Medicine and the St. Louis Veterans Administration Healthcare System, St. Louis, Missouri.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L16-0481. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEconomic Outcomes With Anatomical Versus Functional Diagnostic Testing for Coronary Artery Disease Daniel B. Mark , Jerome J. Federspiel , Patricia A. Cowper , Kevin J. Anstrom , Udo Hoffmann , Manesh R. Patel , Linda Davidson-Ray , Melanie R. Daniels , Lawton S. Cooper , J. David Knight , Kerry L. Lee , Pamela S. Douglas , and Economic Outcomes With Anatomical Versus Functional Diagnostic Testing for Coronary Artery Disease Daniel B. Mark , Pamela S. Douglas , and Melanie R. Daniels Metrics 20 December 2016Volume 165, Issue 12Page: 890-891KeywordsAngiographyCoronary revascularizationExerciseHealth careHeart diseasesHeart rateIschemiaMortalityRadiation therapyStable coronary artery disease ePublished: 20 December 2016 Issue Published: 20 December 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...