Abstract 11490: Coronary Computed Tomography Angiography with Fractional Flow Reserve Outperforms Single-Photon Emission Tomography Myocardial Perfusion Imaging in the Observation Unit

Abstract

Introduction: Coronary Computed Tomography Angiography (CCTA) and SPECT myocardial perfusion imaging (SPECT-MPI) are equally safe in evaluating patients presenting to the emergency department with acute chest pain. However, no study has compared the use of CCTA with Fractional Flow Reserve (FFR-CT) to SPECT-MPI in a chest pain observation unit (OU). We compared the performance of CCTA (with FFR-CT as needed) to SPECT-MPI for change in coronary artery disease (CAD) specific treatment (statins, antianginals, antiplatelets, and coronary revascularization) as well its impact on length of hospital stay (LOS). Methods: In 2020, our institution implemented an algorithm-based protocol in the OU to select patients appropriate for CCTA with explicit guidelines for management based on the results. We performed a retrospective analysis of 105 patients (52 SPECT-MPI patients from the period prior to initiation of the OU CCTA protocol who met criteria for CCTA, and 53 CCTA patients after CCTA protocol initiation). We performed two-tailed t-tests and chi-squared analyses to compare changes in treatment and LOS in both groups. Results: Patients in the CCTA group were younger (61 vs. 67 years, p=0.007), but there were no significant differences in CAD risk factors amongst the two groups. CCTA led to significant increase in statin, antianginal, and antiplatelet therapies, cardiac catheterization and revascularization within 6 months. There was no increase in LOS. Finally, CCTA did not increase acute kidney injury at follow up (Table 1). Conclusion: CCTA with FFR-CT significantly improved patient care by increasing appropriate preventative CAD treatment compared to SPECT-MPI while increasing the rate of revascularization without compromising length of stay or kidney function. In conclusion, protocol-based use of CCTA with FFR-CT is a more effective tool when compared to SPECT-MPI for chest pain patients admitted to the OU.