Clinical and economic impact of stress echocardiography compared with exercise electrocardiography in patients with...

Area of Science:

• Cardiology
• Diagnostic Imaging
• Health Economics

Background:

• Patients with suspected acute coronary syndrome (ACS), non-diagnostic ECG, and negative troponin pose a diagnostic challenge.
• Accurate risk stratification is crucial for appropriate management and resource allocation.

Purpose of the Study:

• To compare the clinical and economic impact of stress echocardiography (SEcho) versus exercise ECG (ExECG) in evaluating these patients.
• To assess diagnostic accuracy, patient outcomes, and cost-effectiveness.

Main Methods:

• A randomized trial comparing SEcho and ExECG in patients with suspected ACS, non-diagnostic ECG, and negative troponin.
• Patients were risk-stratified using the Thrombolysis in Myocardial Infarction (TIMI) score.
• Follow-up for cardiac events and cost analysis were performed.

Main Results:

• SEcho significantly improved low-risk stratification (77% vs. 33%, P<0.0001) compared to ExECG, with similar cardiac event rates (5% vs. 3%).
• SEcho reduced intermediate-risk classification (3% vs. 39%, P<0.0001) and the need for further tests (3% vs. 47%, P<0.0001).
• Diagnostic costs were significantly lower with SEcho (£366.63 vs. £515.48, P=0.004).

Conclusions:

• SEcho demonstrates superiority over ExECG for risk stratification in patients with suspected ACS and negative troponin.
• SEcho leads to reduced diagnostic uncertainty and fewer investigations, offering significant cost benefits.