Related Experiment Video
Updated: Dec 29, 2025
Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
In-Hospital Cost Comparison of Triple-Rule-Out Computed Tomography Angiography Versus Standard of Care in Patients
Richard A P Takx1,2, Julian L Wichmann1,3, Katharina Otani4
1Department of Radiology and Radiological Science, Division of Cardiovascular Imaging.
Insights
Triple-rule-out computed tomography angiography (TRO-CTA) in emergency department (ED) patients with chest pain significantly reduced waiting times, hospital stays, and costs compared to standard care. This imaging approach also lowered return visits and the need for further invasive testing.
Area of Science:
- Cardiology
- Emergency Medicine
- Radiology
Background:
- Acute chest pain is a common emergency department (ED) presentation.
- Diagnostic strategies aim to identify life-threatening conditions efficiently and cost-effectively.
- Triple-rule-out computed tomography angiography (TRO-CTA) offers a comprehensive noninvasive imaging option.
Purpose of the Study:
- To evaluate the utilization of invasive and noninvasive tests.
- To compare costs for patients with chest pain undergoing TRO-CTA versus standard care.
- To assess the impact of TRO-CTA on ED and hospital resource utilization.
Main Methods:
- Retrospective analysis of 2156 ED patients with acute chest pain and negative initial troponin/ECG.
- Comparison of cohorts undergoing TRO-CTA (n=1139) versus standard of care (n=1017).
- Analysis of ED visits, test utilization, and costs during the initial hospital episode.
Main Results:
- No significant differences in diagnosing coronary artery disease, pulmonary embolism, or aortic dissection.
- TRO-CTA group showed significantly lower median ED waiting time (4.5 vs. 7.0 h) and hospital stay (5.0 vs. 32.0 h).
- Lower hospital admission rates (12.6% vs. 54.2%), fewer 30-day return visits (3.5% vs. 14.6%), reduced invasive procedures (4.9% vs. 22.7%), and lower total costs ($11,783 vs. $19,073) in the TRO-CTA group.
Conclusions:
- TRO-CTA as an initial imaging test for acute chest pain in the ED is associated with improved efficiency.
- This approach leads to shorter ED and hospital lengths of stay.
- TRO-CTA ultimately results in lower overall ED and hospitalization costs and fewer revisits.
Purpose:
The purpose of this study was to evaluate the utilization of invasive and noninvasive tests and compare cost in patients presenting with chest pain to the emergency department (ED) who underwent either triple-rule-out computed tomography angiography (TRO-CTA) or standard of care.
Materials And Methods:
We performed a retrospective single-center analysis of 2156 ED patients who presented with acute chest pain with a negative initial troponin and electrocardiogram for myocardial injury. Patient cohorts matched by patient characteristics who had undergone TRO-CTA as a primary imaging test (n=1139) or standard of care without initial CTA imaging (n=1017) were included in the study. ED visits, utilization of tests, and costs during the initial episode of hospital care were compared.
Results:
No significant differences in the diagnosis of coronary artery disease, pulmonary embolism, or aortic dissection were observed. Median ED waiting time (4.5 vs. 7.0 h, P<0.001), median total length of hospital stay (5.0 vs. 32.0 h, P<0.001), hospital admission rate (12.6% vs. 54.2%, P<0.001), and ED return rate to our hospital within 30 days (3.5% vs. 14.6%, P<0.001) were significantly lower in the TRO-CTA group. Moreover, reduced rates of additional testing and invasive coronary angiography (4.9% vs. 22.7%, P<0.001), and ultimately lower total cost per patient (11,783$ vs. 19,073$, P<0.001) were observed in the TRO-CTA group.
Conclusions:
TRO-CTA as an initial imaging test in ED patients presenting with acute chest pain was associated with shorter ED and hospital length of stay, fewer return visits within 30 days, and ultimately lower ED and hospitalization costs.
More Related Videos
06:59Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation
Published on: June 3, 2018
09:32Time-Resolved, Dynamic Computed Tomography Angiography for Characterization of Aortic Endoleaks and Treatment Guidance via 2D-3D Fusion-Imaging
Published on: December 9, 2021
Related Concept Videos
01:28Imaging Studies for Cardiovascular System V: CT
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:13Radiological Investigation III: Pulmonary Angiogram and PET Scan
Pulmonary Angiogram
A Pulmonary Angiogram is an invasive procedure involving injecting a contrast medium through a catheter threaded into the pulmonary artery or the right side of the heart to visualize the pulmonary vasculature. Computed Tomography (CT) scans have mainly replaced this...
01:27Imaging Studies III: Computed Tomography
01:29Angina III: Clinical Manifestations and Assessment
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT