Comparison between Anatomical and Functional Imaging Modalities for Evaluation of Chest Pain in the Emergency Department

ABSTRACT Evaluation of chest pain (CP) in the emergency department (ED) frequently employs a non-invasive strategy, including coronary computed tomography angiography (CCTA), stress echocardiography (SE) or myocardial perfusion imaging (MPI). We sought to report the real-world experience of utilizing CCTA, compared to SE and MPI at an urban hospital ED. We conducted a retrospective cohort study of consecutively enrolled patients presenting with CP who had normal or non-diagnostic ECGs, negative initial troponin-T, at least intermediate risk based on modified Diamond-Forrester criteria (mDF), and who underwent CCTA, SE, or MPI based on their individual test eligibility criteria. The primary outcome was ED discharge time. Secondary outcomes included test utilization and 30-day re-hospitalization rates. In the 2,143 patients who were included (mean age was 56 ±12 years; 55% women) utilization rate (test performed/eligible) was lower for CCTA (n= 354/1329) and MPI (n= 530/1435) compared to SE (n= 1259/1650), P