{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T15:13:13Z","timestamp":1761059593127},"reference-count":41,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2013,9]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>Coronary computed tomographic angiography (cCTA) allows rapid, noninvasive exclusion of obstructive coronary artery disease (CAD). However, concern exists whether implementation of cCTA in the assessment of patients presenting to the emergency department with acute chest pain will lead to increased downstream testing and costs compared with alternative strategies. Our aim was to compare observed actual costs of usual care (UC) with projected costs of a strategy including early cCTA in the evaluation of patients with acute chest pain in the Rule Out Myocardial Infarction Using Computer Assisted Tomography I (ROMICAT I) study.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              We compared cost and hospital length of stay of UC observed among 368 patients enrolled in the ROMICAT I study with projected costs of management based on cCTA. Costs of UC were determined by an electronic cost accounting system. Notably, UC was not influenced by cCTA results because patients and caregivers were blinded to the cCTA results. Costs after early implementation of cCTA were estimated assuming changes in management based on cCTA findings of the presence and severity of CAD. Sensitivity analysis was used to test the influence of key variables on both outcomes and costs. We determined that in comparison with UC, cCTA-guided triage, whereby patients with no CAD are discharged, could reduce total hospital costs by 23% (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). However, when the prevalence of obstructive CAD increases, index hospitalization cost increases such that when the prevalence of \u226550% stenosis is &gt;28% to 33%, the use of cCTA becomes more costly than UC.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>cCTA may be a cost-saving tool in acute chest pain populations that have a prevalence of potentially obstructive CAD &lt;30%. However, increased cost would be anticipated in populations with higher prevalence of disease.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Clinical Trial Registration\u2014<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.clinicaltrials.gov\">http:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              . Unique identifier: NCT00990262.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circoutcomes.113.000244","type":"journal-article","created":{"date-parts":[[2013,9,11]],"date-time":"2013-09-11T11:20:24Z","timestamp":1378898424000},"page":"514-524","update-policy":"http:\/\/dx.doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":27,"title":["Cost and Resource Utilization Associated With Use of Computed Tomography to Evaluate Chest Pain in the Emergency Department"],"prefix":"10.1161","volume":"6","author":[{"given":"Edward","family":"Hulten","sequence":"first","affiliation":[{"name":"From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA (E.H., M.S.B. R.B.); Cardiac MR PET CT Program (A.G., C.L.S., J.N., J.T.N., U.H.) and Division of Cardiology (Q.A.T.), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Radiology, Yale University, New Haven, CT (A.G.); Department of Clinical Radiology, Ludwig-Maximilians University,..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Goehler","sequence":"additional","affiliation":[{"name":"From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA (E.H., M.S.B. R.B.); Cardiac MR PET CT Program (A.G., C.L.S., J.N., J.T.N., U.H.) and Division of Cardiology (Q.A.T.), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Radiology, Yale University, New Haven, CT (A.G.); Department of Clinical Radiology, Ludwig-Maximilians University,..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcio Sommer","family":"Bittencourt","sequence":"additional","affiliation":[{"name":"From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA (E.H., M.S.B. R.B.); Cardiac MR PET CT Program (A.G., C.L.S., J.N., J.T.N., U.H.) and Division of Cardiology (Q.A.T.), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Radiology, Yale University, New Haven, CT (A.G.); Department of Clinical Radiology, Ludwig-Maximilians University,..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabian","family":"Bamberg","sequence":"additional","affiliation":[{"name":"From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA (E.H., M.S.B. R.B.); Cardiac MR PET CT Program (A.G., C.L.S., J.N., J.T.N., U.H.) and Division of Cardiology (Q.A.T.), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Radiology, Yale University, New Haven, CT (A.G.); Department of Clinical Radiology, Ludwig-Maximilians University,..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher L.","family":"Schlett","sequence":"additional","affiliation":[{"name":"From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA (E.H., M.S.B. R.B.); Cardiac MR PET CT Program (A.G., C.L.S., J.N., J.T.N., U.H.) and Division of Cardiology (Q.A.T.), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Radiology, Yale University, New Haven, CT (A.G.); Department of Clinical Radiology, Ludwig-Maximilians University,..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Quynh A.","family":"Truong","sequence":"additional","affiliation":[{"name":"From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA (E.H., M.S.B. R.B.); Cardiac MR PET CT Program (A.G., C.L.S., J.N., J.T.N., U.H.) and Division of Cardiology (Q.A.T.), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Radiology, Yale University, New Haven, CT (A.G.); Department of Clinical Radiology, Ludwig-Maximilians University,..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Nichols","sequence":"additional","affiliation":[{"name":"From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA (E.H., M.S.B. R.B.); Cardiac MR PET CT Program (A.G., C.L.S., J.N., J.T.N., U.H.) and Division of Cardiology (Q.A.T.), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Radiology, Yale University, New Haven, CT (A.G.); Department of Clinical Radiology, Ludwig-Maximilians University,..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khurram","family":"Nasir","sequence":"additional","affiliation":[{"name":"From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA (E.H., M.S.B. R.B.); Cardiac MR PET CT Program (A.G., C.L.S., J.N., J.T.N., U.H.) and Division of Cardiology (Q.A.T.), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Radiology, Yale University, New Haven, CT (A.G.); Department of Clinical Radiology, Ludwig-Maximilians University,..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian S.","family":"Rogers","sequence":"additional","affiliation":[{"name":"From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA (E.H., M.S.B. R.B.); Cardiac MR PET CT Program (A.G., C.L.S., J.N., J.T.N., U.H.) and Division of Cardiology (Q.A.T.), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Radiology, Yale University, New Haven, CT (A.G.); Department of Clinical Radiology, Ludwig-Maximilians University,..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott G.","family":"Gazelle","sequence":"additional","affiliation":[{"name":"From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA (E.H., M.S.B. R.B.); Cardiac MR PET CT Program (A.G., C.L.S., J.N., J.T.N., U.H.) and Division of Cardiology (Q.A.T.), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Radiology, Yale University, New Haven, CT (A.G.); Department of Clinical Radiology, Ludwig-Maximilians University,..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John T.","family":"Nagurney","sequence":"additional","affiliation":[{"name":"From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA (E.H., M.S.B. R.B.); Cardiac MR PET CT Program (A.G., C.L.S., J.N., J.T.N., U.H.) and Division of Cardiology (Q.A.T.), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Radiology, Yale University, New Haven, CT (A.G.); Department of Clinical Radiology, Ludwig-Maximilians University,..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Udo","family":"Hoffmann","sequence":"additional","affiliation":[{"name":"From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA (E.H., M.S.B. R.B.); Cardiac MR PET CT Program (A.G., C.L.S., J.N., J.T.N., U.H.) and Division of Cardiology (Q.A.T.), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Radiology, Yale University, New Haven, CT (A.G.); Department of Clinical Radiology, Ludwig-Maximilians University,..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ron","family":"Blankstein","sequence":"additional","affiliation":[{"name":"From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA (E.H., M.S.B. R.B.); Cardiac MR PET CT Program (A.G., C.L.S., J.N., J.T.N., U.H.) and Division of Cardiology (Q.A.T.), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Radiology, Yale University, New Haven, CT (A.G.); Department of Clinical Radiology, Ludwig-Maximilians University,..."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.11110013"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2006.06.043"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.07.031"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2005.03.022"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.02.074"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.10.011"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2006.08.064"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.03.068"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1201163"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1201161"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.3111\/13696990802134291"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2008.04.045"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.07.3611"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.10.012"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcct.2010.11.005"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.09.066"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.1652"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12350-012-9567-0"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.01.052"},{"key":"e_1_3_3_21_2","first-page":"1893","article-title":"ACC\/AHA guideline update for the management of patients with unstable angina and non\u2013ST-segment elevation myocardial infarction\u20142002: summary article: a report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina).","author":"Braunwald E","year":"2002","unstructured":"Braunwald E, Antman EM, Beasley JW, Califf RM, Cheitlin MD, Hochman JS, Jones RH, Kereiakes D, Kupersmith J, Levin TN, Pepine CJ, Schaeffer JW, Smith EE, Steward DE, Theroux P, Gibbons RJ, Alpert JS, Faxon DP, Fuster V, Gregoratos G, Hiratzka LF, Jacobs AK, Smith SC. 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ACCF\/SCCT\/ACR\/AHA\/ASE\/ASNC\/NASCI\/SCAI\/SCMR 2010 appropriate use criteria for cardiac computed tomography: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. 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