Journal
JOURNAL OF CARDIOVASCULAR COMPUTED TOMOGRAPHY
Volume 11, Issue 5, Pages 373-382Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jcct.2017.08.005
Keywords
Coronary computed tomography angiography; Functional testing; Chest pain; Coronary artery disease
Funding
- National Heart, Lung, and Blood Institute [R01HL098237, R01HL098236, R01HL098305, R01HL098235, R01HL109711]
- American Roentgen Ray Society Scholarship
- Siemens Healthcare
- GE Healthcare
- Philips Healthcare
- Toshiba America Medical Systems
- Eli Lilly
- Bristol-Myers Squibb
- Gilead Sciences
- AGA Medical
- Merck
- Oxygen Biotherapeutics
- AstraZeneca
- Medtronic
- CardioDx
- St. Jude Medical
- HeartFlow
- NATIONAL HEART, LUNG, AND BLOOD INSTITUTE [R01HL098236, R01HL098235, R01HL109711, R01HL098237, R01HL098305] Funding Source: NIH RePORTER
Ask authors/readers for more resources
Background: Coronary computed tomography angiography (CTA) and functional testing strategies for stable chest pain yield similar outcomes; one aspect that may guide test choice is safety. Methods: We compared test safety (test complications, incidental findings, and effective radiation dose) between CTA and functional testing as-tested in PROMISE (PROspective Multicenter Imaging Study for Evaluation of Chest Pain). In the subgroup whose physicians intended nuclear stress over other functional tests if randomized to the functional arm, we compared radiation dose of CTA versus nuclear stress and identified characteristics associated with dose. Results: Of 9470 patients, none had major and <1% had minor complications (CTA: 0.8% [37/4633] vs. functional: 0.6% [27/4837]). CTA identified more incidental findings (11.6% [539/46331 vs. 0.7% [34/4837], p < 0.001), most commonly pulmonary nodules (9.4%, 437/4633). CTA had similar 90-day cumulative radiation dose to functional testing. However, in the subgroup whose physicians intended nuclear stress (CTA 3147; nuclear 3203), CTA had lower median index test (8.8 vs. 12.6 mSv, p < 0.001) and 90-day cumulative (11.6 vs. 13.1 mSv, p < 0.001) dose, independent of patient characteristics. The lowest nuclear doses employed 1-day Tc-99m protocols (12.2 mSv). The lowest CTA doses were at sites performing >= 500 CTAs/year (6.9 mSv) and with advanced (latest available) CT scanners (5.5 mSv). Conclusion: Complications were negligibly rare for both CTA and functional testing. CTA detects more incidental findings. Compared to nuclear stress testing, CTA's lower radiation dose, independent of patient characteristics, makes it an attractive test choice. Radiation dose varies with imaging protocol, indicating opportunities to further reduce dose. (ClinicalTrials.gov number, NCT01174550). (C) 2017 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available