Clinical Impact and Cost-Effectiveness of Coronary Computed Tomography Angiography or Exercise Electrocardiogram in Individuals Without Known Cardiovascular Disease. Issue 21 (May 2015)

• Record Type: Journal Article
• Authors: Park, Gyung-Min; Kim, Seon Ha; Jo, Min-Woo; Her, Sung Ho; Han, Seungbong; Ahn, Jung-Min; Park, Duk-Woo; Kang, Soo-Jin; Lee, Seung-Whan; Kim, Young-Hak; Lee, Cheol Whan; Kim, Beom-Jun; Koh, Jung-Min; Kim, Hong-Kyu; Choe, Jaewon; Park, Seong-Wook; Park, Seung-Jung; Wang., Hsueh
• Is Part Of: Medicine. Volume 94:Issue 21(2015)
• Publication Date: 2015-05
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000000917
• Languages: English
• ISSNs: 0025-7974

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Abstract</title> <p>It is not clear whether screening by coronary computed tomographic angiography (CCTA) and/or exercise electrocardiogram (ECG) can improve clinical outcomes and reduce costs in individuals without known cardiovascular disease (CVD).</p> <p>In total, 71, 811 consecutive individuals without known CVD who underwent general health examinations were enrolled. Using propensity-score matching according to screening tests, 1-year clinical outcomes and 6-month total and coronary artery disease–related medical costs were analyzed in separate groups: group 1 (CCTA [n = 2578] vs no screening [n = 5146]), group 2 (exercise ECG [n = 2898] vs no screening [n = 5796]), and group 3 (CCTA and exercise ECG [n = 2003] vs no screening [n = 4006]).</p> <p>There were no significant differences in the composite outcome of death, myocardial infarction, and stroke in each matched group: group 1 (0.35% vs 0.45%, <italic>P</italic> = 0.501), group 2 (0.14% vs 0.28%, <italic>P</italic> = 0.157), and group 3 (0.25% vs 0.27%, <italic>P</italic> = 0.858). However, revascularization was more frequent in the CCTA screening groups: group 1 (2.02% vs 0.45%, <italic>P</italic> < 0.001) and group 3 (1.40% vs 0.45%, <italic>P</italic> < 0.001). Matched screening groups had higher 6-month total and coronary artery disease–related medical costs: group 1 ($777 vs $603, <italic>P</italic> < 0.001 and $177 vs $39, <italic>P</italic> < 0.001), group 2 ($544 vs $492, <italic>P</italic> = 0.045 and $12 vs $15, <italic>P</italic> = 0.611), and group 3 ($705 vs $627, <italic>P</italic> = 0.090 and $135 vs $35, <italic>P</italic> < 0.001).</p> <p>In individuals without known CVD, CCTA screening with or without exercise ECG led to more frequent revascularization at the expense of higher medical costs, but did not decrease the 1-year risk of death, myocardial infarction, and stroke.</p> </sec> </abstract>