Noninvasive Testing for Chest Pain Adds Time, Expense, and Radiation Exposure, but Does It Prevent Bad Outcomes?

This secondary analysis of data from a randomized trial attempts to answer the question but is vulnerable to unmeasured confounding.

The Rule Out Myocardial Ischemia/Infarction by Computer Assisted Tomography (ROMICAT-II) trial randomized 1000 emergency department (ED) patients with chest pain to coronary computed tomographic angiography (CCTA) or standard care (NEJM JW Cardiol Sep 2012 and N Engl J Med 2012; 367:299). In a secondary analysis of trial data, researchers compared length of stay, cost, radiation exposure, and major adverse cardiac events between 882 patients who underwent CCTA or stress testing and 118 patients in the standard care group who did not undergo noninvasive testing. Testing for patients randomized to standard care was at clinician discretion. The investigators used complex epidemiologic methods to control for confounding by indication (i.e., dif…

Reviewing Author

Daniel J. Pallin, MD, MPH

Disclosures

Consultant/Advisory BoardPortola Pharmaceuticals, Inc.

Speaker’s BureauPeerView Institute for Medical Education

Grant/Research SupportAgency for Healthcare Research and Quality; CDC; NIH–National Center for Advancing Translational Sciences; NIH–National Institute of Allergy and Infectious Diseases (NIAID); NIH–NIAID–Antibacterial Resistance Leadership Group; Merck; Pfizer; Boehringer-Ingelheim; Shire; Portola Pharmaceuticals, Inc.; Novartis; bioMérieux; Siemens; Rapid Pathogen Screening; Magnolia; Stago; Innovative Biosensors; Molecular Detection, Inc.; Dyax Corp.; Trius Pharmaceuticals

Daniel J. Pallin, MD, MPH

Disclosures

Consultant/Advisory BoardPortola Pharmaceuticals, Inc.

Speaker’s BureauPeerView Institute for Medical Education

Noninvasive Testing for Chest Pain Adds Time, Expense, and Radiation Exposure, but Does It Prevent Bad Outcomes?

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Reviewing Author