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CT Angiography and Stress Test Show Similar Costs

By MedImaging International staff writers
Posted on 08 Jun 2016

Image: CT scan of coronary artery centerlines. The PROMISE trial showed CT is as effective as stress tests and SPECT to assess chest pain (Photo courtesy of Duke University).

Computed tomographic angiography (CTA) and functional diagnostic testing strategies for patients with suspected coronary artery disease (CAD) have similar costs, according to a new study.

Researchers at Duke University (Durham, NC, USA), the U.S. National Heart, Lung and Blood Institute (Bethesda, MD, USA), and other institutions conducted a prospective economic study involving 9,649 patients at 190 U.S. centers enrolled in the PROspective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) study between July 2010 and September 2013. Median follow-up was 25 months.

The researchers estimated the technical costs of the initial (outpatient) testing strategy, hospital-based costs and physician fees, discounted at 3% annually and estimated out to three years. The results showed that the mean costs at 90 days were USD 2,494 for the CTA strategy, versus USD 2,240 for the functional strategy, a mean difference of USD 254. The difference was associated with more revascularizations and catheterizations with CTA use. The study was published on May 24, 2016, in Annals of Internal Medicine.

“Despite some fair differences in the prices of these diagnostic tests, there was not a statistical difference between the costs over three years of follow-up,” said lead Daniel Mark, MD, MPH, of Duke. “Coronary CT angiography may not be quite the hoped-for holy grail of cardiology, but its more liberal use following the standards set in PROMISE will not hurt patients, and will not cause a major additional cost burden on the health care system.”

Current guidelines of the American Heart Association (AHA, Dallas, TX, USA) and the American College Cardiology (ACC) call for a stress tests in all patients who show signs of CAD to confirm the diagnosis and define severity of the blockage. CTA is reserved only for patients with borderline stress test results. However, according to the researchers, the much higher accuracy of CTA may be a better first-line test in people with symptoms suggestive of a blocked artery.

Related Links:
Duke University
U.S. National Heart, Lung and Blood Institute

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68 (!!!!! 5454.0634155273): SELECT fid FROM jos_deeppockets WHERE id=294764510 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294764510 AND published='1' LIMIT 1

69 (!!!!! 1216.8884277344): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

70 (!!!!! 1065.9694671631): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294764510 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (733.85238647461): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294764510 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (234.84230041504): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (388.86070251465): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (145.91217041016): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (124.93133544922): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (178.09867858887): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (160.93254089355): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (32.186508178711): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (142.09747314453): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (144.00482177734): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (401.02005004883): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294764510 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (225.06713867188): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294764510 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (40.769577026367): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (!!!!! 3010.9882354736): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (45.7763671875): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (799.17907714844): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (535.01129150391): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (567.91305541992): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (52.928924560547): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (324.96452331543): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (51.021575927734): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (48.160552978516): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (226.97448730469): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (292.06275939941): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 1491.0697937012): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294764510 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294764510 AND published='1' LIMIT 1

105 (799.17907714844): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294764510 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294764510 AND published='1' LIMIT 1

106 (470.16143798828): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294764510 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (828.02772521973): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294764510 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 11639.11819458): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294764510 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294764510 AND published='1' LIMIT 1

109 (!!!!! 5627.1553039551): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294764510 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294764510 AND published='1' LIMIT 1

110 (!!!!! 3372.9076385498): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294764510 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (!!!!! 1327.9914855957): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294764510 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (696.18225097656): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (504.97055053711): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294764510 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294764510 AND published='1' LIMIT 1

115 (73.19450378418): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294764510 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294764510 AND published='1' LIMIT 1

116 (!!!!! 2408.9813232422): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294764510 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294764510 AND published='1' LIMIT 1

117 (474.92980957031): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294764510 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294764510 AND published='1' LIMIT 1

118 (394.10591125488): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294764510 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294764510 AND published='1' LIMIT 1

119 (!!!!! 2024.8889923096): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294764510 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294764510 AND published='1' LIMIT 1

120 (861.88316345215): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294764510 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294764510 AND published='1' LIMIT 1

121 (463.00888061523): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294764510 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294764510 AND published='1' LIMIT 1

122 (676.87034606934): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 68112.134933472): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

124 (!!!!! 1343.9655303955): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294764510 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294764510 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 5280.9715270996): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (!!!!! 9997.8446960449): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (!!!!! 2122.8790283203): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (325.91819763184): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (686.8839263916): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (41.007995605469): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (221.01402282715): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (34.093856811523): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (!!!!! 1723.051071167): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (225.06713867188): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (!!!!! 6054.162979126): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294764510 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (!!!!! 4238.1286621094): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294764510 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (679.01611328125): SELECT name FROM jos_deeppockets WHERE id=211

138 (!!!!! 6233.9305877686): SELECT name FROM jos_deeppockets WHERE id=211

139 (986.09924316406): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (597.00012207031): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (!!!!! 1592.8745269775): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294764510 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294764510 AND published='1' LIMIT 1

142 (241.99485778809): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294764510 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294764510 AND published='1' LIMIT 1

143 (!!!!! 15543.937683105): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 7668.0183410645): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294764510 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (681.87713623047): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294764510 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 3762.0067596436): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294764510 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (65.803527832031): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294764510 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (679.96978759766): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294764510 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294764510 AND published='1' LIMIT 1

149 (185.96649169922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294764510 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294764510 AND published='1' LIMIT 1

150 (!!!!! 3375.0534057617): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

151 (277.99606323242): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294764510 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294764510 AND published='1' LIMIT 1

152 (52.928924560547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294764510 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294764510 AND published='1' LIMIT 1

153 (656.1279296875): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294764510 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294764510 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (756.97898864746): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

155 (43.869018554688): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

156 (215.05355834961): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (510.93101501465): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294764510 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294764510 AND published='1' LIMIT 1

158 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294764510 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294764510 AND published='1' LIMIT 1

159 (!!!!! 1040.9355163574): select jos_twitters.link from jos_twitters where cat=10

160 (37.908554077148): select jos_facebook.link from jos_facebook where cat=10

161 (150.20370483398): select jos_google_plus.link from jos_google_plus where cat=10

162 (37.908554077148): select jos_linkedin.link from jos_linkedin where cat=10

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