ROMICAT II Demonstrates the Benefit of CTA to Evaluate Suspected Heart Attack

March 27, 2012—Findings from the ROMICAT II study demonstrated that cardiac computed tomographic angiography (CTA) scans save patients and hospitals time and money when used early to evaluate chest pain. By providing a virtually instant verdict on whether chest pain is being caused by a blockage of the coronary arteries, CTA allows emergency department doctors to quickly determine whether a patient should be admitted for treatment of a heart attack.

ROMICAT II's Lead Investigator, Udo Hoffmann, MD, presented the study at the American College of Cardiology's (ACC) annual scientific sessions in Chicago. The study was funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health.

According to the ACC, the ROMICAT II study involved 1,000 patients at nine hospitals across the United States. The results showed that using CTA scans to evaluate patients with chest pain in the emergency department reduced patients' average time spent in the hospital by 18 hours. Half of the patients who underwent CTA scans were safely discharged within 9 hours compared to only 15% of patients receiving standard care. The use of CTA resulted in 10% to 20% cost savings to the emergency department over standard care.

The study enrolled patients who arrived to the emergency department with chest pain and who were at intermediate risk for a heart attack based on their symptoms and initial evaluation, which included blood tests and electrocardiography results. Patients were randomly assigned to undergo either a CTA scan as their first diagnostic test or standard care, which could include a cardiac stress test or no tests at all, depending on the patient's condition and physician preference. Because healthy patients were discharged much earlier and often only needed a CTA scan and a single blood test, their health care costs were lower.

“These data suggest that doing a CT scan early benefits both patients and physicians,” commented Dr. Hoffmann. “Physicians benefit because they can discharge many patients from the overcrowded ER very quickly, with solid reassurance that they're not having a heart attack, while the standard evaluation takes much longer to assess whether the symptoms stem from blockages in their arteries. Patients benefit from an earlier diagnosis and can safely go home from the ER earlier.”

Dr. Hoffmann added, “It looks like CT saves time and money for the health care system in those who have no blockages in their coronary arteries. Though only a modest amount of money is saved per patient, it may save a lot of money considering the millions of patients affected across the country. CT allows you to spend your health care dollars focusing on the people who are actually sick. One could argue that this is a better use of health care resources.”

CT scans also provide useful prognostic information that doctors can refer back to if the patient experiences chest pain again. Dr. Hoffman explained, “If their CT scan shows clear heart arteries, we know from our previous ROMICAT I study that their prognosis over the next 2 years is really good, which can be useful farther down the road.”

The ACC noted that other studies have offered somewhat conflicting assessments of the efficiency and effectiveness of using CTA scans as the first diagnostic test for chest pain. This trial is unique because the scan was performed much earlier in the evaluation process compared to other studies and was used in a real-life setting. Moreover, this was the first trial to show that physicians could act on information from the CT scan in a way that improved a measure of care—safe early discharge—after emergency department presentation for chest pain. “It shows that cardiac CT is ready for use in a pragmatic health care setting, as it is more effective than the standard ER evaluation,” concluded Dr. Hoffmann.