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Heart Imaging Called Into Question for Mild Chest Pain

CardioSmart News

There’s no clear winner when comparing tests used to evaluate chest pain, according to results of the largest-ever heart imaging study recently presented at the American College of Cardiology’s 64th Annual Scientific Session in San Diego.

Also published in the New England Journal of Medicine, this study pit the top heart tests against each other to see which worked best to assess chest pain (also known as angina)—a common symptom of heart attack and other serious heart conditions. Each year, chest pain accounts for roughly four million stress tests in the United States, yet little is known about whether one test is better than others in diagnosing the cause of chest pain.

That’s why the federally funded PROMISE trial—Prospective Multicenter Imaging Study for the Evaluation of Chest Pain—compared 3D heart imaging exams with older stress tests across 193 health centers in the U.S. and Canada. Researchers compared CT scans (computerized tomography coronary angiograms), which provide 3-D images of the heart’s arteries, with three types of stress tests that use a radioactive dye to measure heart function. The goal of the study was to identify which test works best to improve outcomes, especially since some expose patients to varying levels of radiation.

The good news is that among more than 10,000 patients included in the study, outcomes were very good. After following patients for two years after their heart tests, only 3% of patients went on to experience serious complications, such as heart attack, hospitalization or death. All of the tests worked equally well in predicting risk of such complications. However, CT scans were more accurate in identifying patients which needed appropriate follow-up testing and heart procedures.

In a separate analysis, researchers found no real cost difference between the heart tests analyzed in the PROMISE trial. On average, heart CT scans cost $404, which was less than most stress tests. However, after taking into account expenses from additional treatments, costs were similar across the board.

“This information provides tremendous value, even if the answer is that there is not much difference between the two tests,” said Daniel Mark, MD, the economic study’s lead author. “It’s an answer and a useful answer that can help drive decision making.”

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