CCTA utilization for ED patients with acute chest pain is up, but MPI still more common

Coronary CT angiography (CCTA) has been found to be more efficient than myocardial perfusion imaging (MPI) for emergency department (ED) patients presenting with acute chest pain, but many physicians are still turning to MPI, according to a study published in the American Journal of Roentgenology.

The authors examined Medicare Part B data from 2006 to 2015. Research showing the effectiveness of CCTA compared to MPI was published in 2011 and 2012.

Overall, there was “essentially no change” in the number of MPI examinations performed in EDs for Medicare patients presenting with acute chest pain; there were 22,342 in 2006 and 22,338 I 2015. The number of CCTA examinations increased significantly, however, jumping from more than 100 in 2006 to more than 1,900 in 2015. The number of stress echocardiograms also barely changed during this timeframe; 3,544 were performed in 2006 compared to 3,520 in 2015.

“The data indicate little change in the use of MPI and stress echocardiography in EDs over the period of study,” wrote lead author David C. Levin, with the department of radiology at Thomas Jefferson University Hospital in Philadelphia, and colleagues. “The use of CCTA has increased rapidly but still remains well below that of MPI and, to a lesser extent, stress echocardiography. The increase in CCTA use is appropriate, given the findings of three major randomized trials that included ED patients with chest pain.”

Levin et al. emphasized that chest pain is the second most common cause of patient visits to EDs in the United States, racking up approximately $12 billion annually. Previous studies have shown that CCTA can lead to a shorter length of stay in the ED, an increased likelihood of the patient being discharged directly from the ED and lower total ED costs.

The authors also highlighted a separate benefit to providers turning to CCTA. “Another important advantage of using CCTA to evaluate patients with chest pain in the ED is that if it is performed as a so-called triple rule-out examination it can be used to exclude other causes of acute chest pain, such as pulmonary embolism, aortic dissection, pericardial effusion, and pneumothorax,” the authors wrote. “MPI and stress echocardiography cannot be used for that purpose.”

Radiologists, Levin and colleagues concluded, interpret a majority of CCTA examinations performed in EDs and they have an opportunity to “educate their emergency medicine colleagues” about the advantages of CCTA when evaluation ED patients with chest pain.