European Heart Journal Advance Access originally published online on January 16, 2007
European Heart Journal 2007 28(2):204-211; doi:10.1093/eurheartj/ehl444
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Clinical and economic impact of stress echocardiography compared with exercise electrocardiography in patients with suspected acute coronary syndrome but negative troponin: a prospective randomized controlled study
1 Department of Cardiovascular Medicine, Northwick Park Hospital and Institute for Medical Research, Watford Road, Harrow, Middlesex HA1 3UJ, UK
2 Health Economics Research Group, Brunel University, Uxbridge, Middlesex, UK
Received 1 August 2006; revised 21 November 2006; accepted 30 November 2006; online publish-ahead-of-print 16 January 2007.
* Corresponding author. Tel: +44 208 869 2547/8; fax: +44 208 864 0075. E-mail address: roxysenior{at}cardiac-research.org
See page 148 for the editorial comment on this article (doi:10.1093/eurheartj/ehl432)
Aims Patients attending hospital with suspected acute coronary syndrome (ACS), non-diagnostic electrocardiogram (ECG), and negative troponin present a diagnostic dilemma for admitting physicians. We sought to determine the clinical and economic impact of stress echocardiography (SEcho) when compared with exercise ECG (ExECG) in the assessment of these patients.
Methods and results Following pre-test assessment by (Thrombolysis in Myocardial Infarction) TIMI score, patients were randomized to ExECG (n = 218) or SEcho (n = 215). Subsequently, low-risk patients were discharged; those considered high risk were referred for coronary angiography. Patients were followed-up for cardiac events and a cost-analysis performed. SEcho was superior to ExECG in stratifying patients as low risk (77 vs. 33%, respectively, P < 0.0001) with no difference in cardiac event rate (5 vs. 3%, respectively). SEcho classified fewer patients as intermediate risk (3 vs. 39%, respectively, P < 0.0001) and fewer patients required further tests when compared with ExECG (3 vs. 47%, respectively, P < 0.0001). Costs for detection of coronary artery disease were significantly less in patients undergoing SEcho (£366.63 vs. £515.48, P = 0.004).
Conclusion SEcho is superior to ExECG in the risk stratification of patients with suspected ACS but negative troponin. SEcho resulted in less diagnostic uncertainty, fewer referrals for further investigation, and hence, a significant cost benefit over ExECG.
Key Words: Echocardiography • Prognosis • Coronary disease
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