{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:07:36Z","timestamp":1785409656581,"version":"3.56.0"},"reference-count":19,"publisher":"IMR Press","issue":"7","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Cardiovasc. Med."],"abstract":"<jats:p>Background:Emergency chest pain presentations represent a substantial burden on healthcare resources. The use of coronary computed tomography angiography (CCTA) has been shown to be safe and associated with reduced costs in stable outpatients referred for invasive coronary angiography (ICA). The history, electrocardiogram, age, risk factors, troponin (HEART) risk assessment score is used to risk-stratify patients with undifferentiated chest pain. We sought to evaluate the cost impact of an accelerated outpatient CCTA-based diagnostic pathway compared with inpatient ICA for the investigation of patients presenting acutely to the emergency department (ED) with symptoms suggestive of coronary artery disease (CAD) at a tertiary referral centre. Methods:We performed a comparative cost analysis based on retrospective observational data including stable adult ED patients who presented in 2023.Results:369 patients underwent outpatient CCTA and 376 were admitted for ICA. The median time to outpatient CCTA was 14 days (interquartile range (IQR) 5\u201324). Use of the CCTA-based pathway was associated with a 78% reduction in diagnostic pathway costs (\u20ac2990 per patient), when compared to admission for ICA, for the investigation of lower-risk individuals, with no increase in 30-day mortality or myocardial infarction. Patients referred for outpatient CCTA had a significantly shorter median length-of-stay compared with those admitted for ICA (6.5 hours (IQR 5.0\u20139.0) vs. 5 days (IQR 3.0\u201314.9); p &lt; 0.05). Conclusions:Use of an accelerated outpatient CCTA-based diagnostic pathway for low-risk chest pain patients in the ED was associated with substantial cost savings and reduced hospital utilization without evidence of compromised short-term safety.<\/jats:p>","DOI":"10.31083\/rcm50184","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T10:31:43Z","timestamp":1785407503000},"source":"Crossref","is-referenced-by-count":0,"title":["Cost Impact of a Coronary Computed Tomography Angiography-Based Diagnostic Pathway for Low-Risk Chest Pain in the Emergency Department"],"prefix":"10.31083","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-4309-2811","authenticated-orcid":true,"given":"Ryan","family":"Karlsson","sequence":"first","affiliation":[{"name":"Department of Cardiology, St James\u2019s Hospital, D08 NHY1 Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Cronin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, St James\u2019s Hospital, D08 NHY1 Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niall","family":"Sheehy","sequence":"additional","affiliation":[{"name":"Department of Radiology, St James\u2019s Hospital, D08 NHY1 Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geraldine","family":"McMahon","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, St James\u2019s Hospital, D08 NHY1 Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ross T","family":"Murphy","sequence":"additional","affiliation":[{"name":"Department of Cardiology, St James\u2019s Hospital, D08 NHY1 Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Daly","sequence":"additional","affiliation":[{"name":"Department of Cardiology, St James\u2019s Hospital, D08 NHY1 Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"16242","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Miller JM, Rochitte CE, Dewey M, Arbab-Zadeh A, Niinuma H, Gottlieb I, et al. Diagnostic performance of coronary angiography by 64-row CT. The New England Journal of Medicine. 2008; 359: 2324\u20132336.","DOI":"10.1056\/NEJMoa0806576"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Mowatt G, Cummins E, Waugh N, Walker S, Cook J, Jia X, et al. Systematic review of the clinical effectiveness and cost-effectiveness of 64-slice or higher computed tomography angiography as an alternative to invasive coronary angiography in the investigation of coronary artery disease. Health Technology Assessment (Winchester, England). 2008; 12.","DOI":"10.3310\/hta12170"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Serruys PW, Kotoku N, N\u00f8rgaard BL, Garg S, Nieman K, Dweck MR, et al. Computed tomographic angiography in coronary artery disease. EuroIntervention. 2023; 18: e1307\u2013e1327.","DOI":"10.4244\/EIJ-D-22-00776"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Knuuti J, Ballo H, Juarez-Orozco LE, Saraste A, Kolh P, Rutjes AWS, et al. The performance of non-invasive tests to rule-in and rule-out significant coronary artery stenosis in patients with stable angina: a meta-analysis focused on post-test disease probability. European Heart Journal. 2018; 39: 3322\u20133330.","DOI":"10.1093\/eurheartj\/ehy267"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Vrints C, Andreotti F, Koskinas KC, Rossello X, Adamo M, Ainslie J, et al. 2024 ESC guidelines for the management of chronic coronary syndromes: developed by the task force for the management of chronic coronary syndromes of the European Society of Cardiology (ESC) endorsed by the European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal. 2024; 45: 3415\u20133537.","DOI":"10.1093\/eurheartj\/ehae177"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"SCOT-HEART Investigators, Newby DE, Adamson PD, Berry C, Boon NA, Dweck MR, et al. Coronary CT Angiography and 5-Year Risk of Myocardial Infarction. The New England Journal of Medicine. 2018; 379: 924\u2013933.","DOI":"10.1056\/NEJMoa1805971"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Lubbers M, Dedic A, Coenen A, Galema T, Akkerhuis J, Bruning T, et al. Calcium imaging and selective computed tomography angiography in comparison to functional testing for suspected coronary artery disease: the multicentre, randomized CRESCENT trial. European Heart Journal. 2016; 37: 1232\u20131243.","DOI":"10.1093\/eurheartj\/ehv700"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Hamilton-Craig C, Fifoot A, Hansen M, Pincus M, Chan J, Walters DL, et al. Diagnostic performance and cost of CT angiography versus stress ECG--a randomized prospective study of suspected acute coronary syndrome chest pain in the emergency department (CT-COMPARE). International Journal of Cardiology. 2014; 177: 867\u2013873.","DOI":"10.1016\/j.ijcard.2014.10.090"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Hollander JE, Gatsonis C, Greco EM, Snyder BS, Chang AM, Miller CD, et al. Coronary Computed Tomography Angiography Versus Traditional Care: Comparison of One-Year Outcomes and Resource Use. Annals of Emergency Medicine. 2016; 67: 460\u2013468.e1.","DOI":"10.1016\/j.annemergmed.2015.09.014"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Cronin M, Gill A, Blake E, Dunne N, Sheehy N, McMahon G, et al. The early after discharge cardiac CT for low-risk chest pain study: the ED-CT study. The British Journal of Radiology. 2024; 97: 1483\u20131491.","DOI":"10.1093\/bjr\/tqae119"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Netherlands Heart Journal. 2008; 16: 191\u2013196.","DOI":"10.1007\/BF03086144"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Chang HJ, Lin FY, Gebow D, An HY, Andreini D, Bathina R, et al. Selective Referral Using CCTA Versus Direct Referral for Individuals Referred to Invasive Coronary Angiography for Suspected CAD: A Randomized, Controlled, Open-Label Trial. JACC. Cardiovascular Imaging. 2019; 12: 1303\u20131312.","DOI":"10.1016\/j.jcmg.2018.09.018"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Rudzi\u0144ski PN, Kruk M, K\u0119pka C, Schoepf UJ, Otani K, Leonard TJ, et al. Assessing the value of coronary artery computed tomography as the first-line anatomical test for stable patients with indications for invasive angiography due to suspected coronary artery disease. Initial cost analysis in the CAT-CAD randomized trial. Journal of Cardiovascular Computed Tomography. 2020; 14: 75\u201379.","DOI":"10.1016\/j.jcct.2019.07.008"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Hoffmann U, Truong QA, Schoenfeld DA, Chou ET, Woodard PK, Nagurney JT, et al. Coronary CT angiography versus standard evaluation in acute chest pain. The New England Journal of Medicine. 2012; 367: 299\u2013308.","DOI":"10.1056\/NEJMoa1201161"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"Dedic A, Lubbers MM, Schaap J, Lammers J, Lamfers EJ, Rensing BJ, et al. Coronary CT Angiography for Suspected ACS in the Era of High-Sensitivity Troponins: Randomized Multicenter Study. Journal of the American College of Cardiology. 2016; 67: 16\u201326.","DOI":"10.1016\/j.jacc.2015.10.045"},{"key":"ref16","unstructured":"Department of Health. Acute Hospital Inpatient Bed Capacity Expansion Plan 2024\u20132031. 2024. Available at: https:\/\/www.gov.ie\/en\/department-of-health\/publications\/acute-hospital-inpatient-bed-capacity-expansion-plan-2024-2031\/ (Accessed: 3 January 2026)."},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"Dai N, Zhang X, Zhang Y, Hou L, Li W, Fan B, et al. Enhanced diagnostic utility achieved by myocardial blood analysis: A meta-analysis of noninvasive cardiac imaging in the detection of functional coronary artery disease. International Journal of Cardiology. 2016; 221: 665\u2013673.","DOI":"10.1016\/j.ijcard.2016.07.031"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"Ricci F, Khanji MY, Bisaccia G, Cipriani A, Di Cesare A, Ceriello L, et al. Diagnostic and Prognostic Value of Stress Cardiovascular Magnetic Resonance Imaging in Patients With Known or Suspected Coronary Artery Disease: A Systematic Review and Meta-analysis. JAMA Cardiology. 2023; 8: 662\u2013673.","DOI":"10.1001\/jamacardio.2023.1290"},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"Takx RAP, Blomberg BA, El Aidi H, Habets J, de Jong PA, Nagel E, et al. Diagnostic accuracy of stress myocardial perfusion imaging compared to invasive coronary angiography with fractional flow reserve meta-analysis. Circulation. Cardiovascular Imaging. 2015; 8: e002666.","DOI":"10.1161\/CIRCIMAGING.114.002666"}],"container-title":["Reviews in Cardiovascular Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.imrpress.com\/journal\/RCM\/27\/7\/10.31083\/RCM50184","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T10:32:22Z","timestamp":1785407542000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.imrpress.com\/journal\/RCM\/27\/7\/10.31083\/RCM50184"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,21]]},"references-count":19,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026]]}},"alternative-id":["S1530-6550(26)03310-0"],"URL":"https:\/\/doi.org\/10.31083\/rcm50184","relation":{},"ISSN":["1530-6550","2153-8174"],"issn-type":[{"value":"1530-6550","type":"print"},{"value":"2153-8174","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,21]]},"article-number":"50184"}}