Key result
Preoperative MDCT and ATP-SPECT screening linked to ~25% lower medical expenses vs cardiac catheterization.
Why the study?
Does non-invasive screening with MDCT and ATP-SPECT reduce medical expenses without increasing perioperative cardiac events compared to cardiac catheterization in patients scheduled for non-cardiac surgery with abnormal initial screening?
Observational (n=1,657)
No
Does non-invasive screening with MDCT and ATP-SPECT reduce medical expenses without increasing perioperative cardiac events compared to cardiac catheterization in patients scheduled for non-cardiac surgery with abnormal initial screening?
Absolute Event Rate: 140030% vs 187170%
p-value: p=0.0002
Non-invasive preoperative CAD screening with MDCT and ATP-SPECT is as safe as invasive cardiac catheterization but significantly reduces medical expenses.
Non-invasive screening was associated with lower costs; leaves open need for RCTs to confirm safety before changing preoperative protocols.
OBJECTIVE: The goal of this study was to investigate the utility of multidetector-row computed tomography (MDCT) and adenosine triphosphate stress cardiac single photon emission computed tomography (ATP-SPECT) in evaluating coronary artery disease (CAD) in patients scheduled for non-cardiac surgery. PATIENTS AND METHODS: We routinely performed echocardiography and exercise stress electrocardiography as preoperative cardiac screening examinations for patients scheduled for non-cardiac surgery under general anesthesia. Of 848 consecutive preoperative patients (Non-invasive Group), 49 patients with abnormalities of these screening examinations had MDCT and ATP-SPECT. Of 809 consecutive preoperative patients studied at an earlier time (Invasive Group), 58 patients with abnormalities of these screening examinations had cardiac catheterization as an additional cardiac examination. RESULTS: The number of patients in the non-invasive and invasive subgroups having additional screening examinations was comparable, and there was no significant difference in perioperative cardiac events between the two subgroups. Based on results of the additional tests in the two subgroups, preoperative prophylactic invasive treatment for CAD was carried out in a small number of patients, again with no significant differences between the groups. However, total medical expenses for the additional cardiac examinations were significantly reduced in the non-invasive subgroup compared with the invasive subgroup (140,030+/-34,800 vs. 187,170+/-26,120 yen, respectively, p=0.0002). CONCLUSION: Non-invasive examination prior to noncardiac surgery using MDCT and ATP-SPECT in a subgroup of patients suspected of having CAD appears to be a useful screening procedure. Compared with invasive cardiac catheterization, CT testing has comparable diagnostic utility without an increase in perioperative cardiac events, and in addition, it has an improved cost-benefit profile.
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Kaneko et al. (2010) conducted an observational in Coronary artery disease screening prior to noncardiac surgery (n=1,657). MDCT and ATP-SPECT vs. Cardiac catheterization was evaluated on Total medical expenses for additional cardiac examinations (yen) (p=0.0002). Non-invasive preoperative screening using MDCT and ATP-SPECT significantly reduced total medical expenses compared to invasive cardiac catheterization (140,030 vs. 187,170 yen, p=0.0002).
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