Abstract P235: The Impact of Coronary Computed Tomography Angiography on Near-Term Resource Utilization in Patients With Prior Stress Tests

Abstract

Objectives: Coronary Computed Tomography Angiography (CCTA) has emerged as a new tool for non-invasive detection of coronary artery disease (CAD). However, its impact on near term downstream resource utilization is not known. The aim of this study is to determine the impact of CCTA on near term post resource utilization in patients with recent prior stress tests (<one year). Methods: The study population consisted of 454 consecutive patients at a single tertiary care center who underwent CCTA between 1/2006 and 6/2009. Patients were followed up for six months to determine the rate of hospitalization, emergency room visit, coronary angiography, revascularization and additional stress testing. Results: Of the 454 patients included, 33%, 58% and 10% had normal, abnormal and equivocal stress test respectively. There was no difference in the prevalence of obstructive CAD among patients with normal or abnormal stress tests (figure). Normal CCTA were associated with low resource utilization. To establish the diagnosis of CAD, a CCTA-based approach to abnormal or equivocal stress test was associated with a cost saving of $579 per patient compared to a coronary angiography based approach. Conclusions: Our data suggest that a normal CCTA after stress testing is associated with very low rate of subsequent resource utilization. Six Months Resource Utilization in Patients with Prior Stress Test No Coronary Artery Disease N=183 Non Obstructive Coronary Artery Disease N=186 Obstructive Coronary Artery Disease N=85 P value Emergency visits 15 (8.2%) 14 (7.5%) 10 (11.8%) 0.50 Cardiac Hospitalizations 2 (1.1%) 3 (1.6%) 15 (17.7%) <0.0001 Stress tests 8 (4.4%) 6 (3.2%) 11 (12.9%) 0.0034 Cardiac Catheterization 2 (1.1%) 9 (4.8%) 41 (48%) <0.0001 Revascularization 0 0 19 (4%) <0.0001 Any Resource Utilization 24 (13%) 28 (15.1%) 50 (58.8%) <0.001