Key result
Initial ETT with imaging when equivocal proves more cost-effective than initial imaging for suspected CAD.
Why the study?
Does initial exercise treadmill testing improve cost-effectiveness compared to initial imaging in individuals with stable chest pain and suspected coronary artery disease?
Does initial exercise treadmill testing improve cost-effectiveness compared to initial imaging in individuals with stable chest pain and suspected coronary artery disease?
An initial strategy of exercise treadmill testing followed by imaging if needed is more cost-effective than initial imaging for evaluating stable chest pain.
May support treadmill-first evaluation to lower costs in stable chest pain; leaves open prospective outcome trials before practice change.
PURPOSE: To determine lifetime cost-effectiveness of diagnostic evaluation strategies for individuals with stable chest pain and suspected coronary artery disease (CAD). METHODS: Exercise treadmill testing (ETT), stress echocardiography (SE), myocardial perfusion scintigraphy (MPS), coronary computed tomographic angiography (CCTA), and invasive coronary angiography (ICA) were assessed alone, or in succession to each other. RESULTS: Initial ETT followed by imaging wherein ETT was equivocal or unable to be performed appeared more cost-effective than any strategy employing initial testing by imaging. CONCLUSION: As pre-test likelihood of CAD varies, different modalities including SE, CCTA, and MPS result in improved costs and enhanced effectiveness.
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Min et al. (2017) studied stable chest pain syndrome and suspected coronary artery disease. Initial exercise treadmill testing (ETT) followed by imaging vs. Initial testing by imaging was evaluated on lifetime cost-effectiveness. Initial exercise treadmill testing followed by imaging when equivocal was more cost-effective than any strategy employing initial testing by imaging for suspected coronary artery disease.
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