Comparison of two strategies in a chest pain unit: stress echocardiography and multidetector computed tomography

Abstract

Introduction and objectives: This study aimed to compare stress echocardiography (SE) and multidetector computed tomography (MCT) in patients admitted to a chest pain unit to detect acute coronary syndrome (ACS).

Methods: A total of 203 patients with ≥ 1 cardiovascular risk factor, no ischemic electrocardiogram changes and negative biomarkers were randomized to SE (n=103) or MTC (n=100). The primary endpoint was a combination of hard events (death and nonfatal myocardial infarction), revascularizations, and readmissions during follow-up. The secondary endpoint was the cost of the 2 strategies.

Results: Invasive angiography was performed in 61 patients (34 [33%] in the SE group and in 27 [27%] in the MCT group, P=.15). A final diagnosis of ACS was made in 53 patients (88% vs 85%, P=.35). There were no significant differences between groups in the primary endpoint (42% vs 41%, P=.91), or in hard events (5% vs 7%, P=.42). There were no significant differences in overall cost, but costs were lower in patients with negative SE than in those with negative MCT (€557 vs €706, P <.02).

Conclusions: No significant differences were found in efficacy and safety for the stratification of patients with a low to moderate probability of ACS admitted to a chest pain unit. The cost of the 2 strategies was similar, but cost was significantly lower for SE on comparison of negative studies.

Keywords: Acute coronary syndrome; Chest pain unit; Ecocardiograma de estrés; Multidetector computed tomography; Stress echocardiography; Síndrome coronario agudo; Tomografía computarizada con multidetectores; Unidad de dolor torácico.