Background
Methods
Definitions of strategies
Patient population
Total population | Atypical chest pain | Typical angina |
p-values a
| |
---|---|---|---|---|
Demographics | ||||
n (%) | 3’647 (100 %) | 1’786 (49.0 %) | 582 (16.0 %) | - |
Male (%)†
| 58.7 % | 45.7 % | 42.8 % | <0.001 |
Age at baseline (y); mean (range) ‡
| 61.6 (14–92) | 61.1 (14–92) | 62.6 (26–88) | <0.05 |
Weight (kg); mean (range) §
| 80.4 (28–183) | 80.2 (30–183) | 79.7 (28–182) | ns |
Risk profile | ||||
Hypertension §
| ns | |||
- none | 38.1 % | 39.1 % | 35.4 % | |
- treated | 58.1 % | 56.7 % | 60.3 % | |
- untreated | 3.9 % | 4.3 % | 4.3 % | |
Dyslipidemia ǁ
| 42.2 % | 40.5 % | 45.9 % | 0.059 |
Diabetes mellitus ǁ
| 13.3 % | 10.8 % | 15.0 % | <0.001 |
Smoker ǁ
| ns | |||
- No | 74.5 % | 73.9 % | 73.9 % | |
- Current | 12.9 % | 12.9 % | 13.8 % | |
- Previous | 12.7 % | 13.2 % | 12.4 % | |
Family history of CAD §
| 27.0 % | 28.3 % | 29.4 % | <0.05 |
Reasons for CAD work-up | ||||
- Patient complaints | 72.7 % | 89.7 % | 89.7 % | <0.001 |
- Presence of cardiovascular risk factors | 55.9 % | 53.4 % | 53.1 % | <0.001 |
- Ambiguous Stress ECG | 20.2 % | 17.4 % | 14.4 % | <0.001 |
- Ambiguous Stress Echocardiography | 1.9 % | 1.4 % | 1.2 % | <0.01 |
- Ambiguous Stress SPECT | 0.3 % | 0.2 % | 0.5 % | ns |
- Ambiguous Cardiac CT | 0.9 % | 0.7 % | 0.5 % | ns |
Treatment: n (%) | ||||
Revascularizations | 226 (6.2 %) | 81 (4.5 %) | 75 (12.9 %) | <0.001 |
- PCI only | 179 (4.9 %) | 70 (3.9 %) | 53 (9.1 %) | <0.001 |
- CABG only | 41 (1.1 %) | 10 (0.6 %) | 19 (3.3 %) | <0.001 |
- PCI and CABG | 6 (0.2 %) | 1 (0.1 %) | 3 (0.5 %) | 0.059 |
Outcome (complications): n (%) | ||||
Primary endpoint | 75 (2.1 %) | 33 (1.9 %) | 11 (1.9 %) | ns |
- Mortality : all cause | 34 (0.9 %) | 15 (0.8 %) | 7 (1.2 %) | ns |
- Cardiac death | 7 (0.2 %) | 6 (0.4 %) | 0 (0.0 %) | ns |
- Cardiac death and unknown cause | 23 (0.6 %) | 13 (0.7 %) | 2 (0.3 %) | ns |
- Non-fatal myocardial infarction | 11 (0.3 %) | 5 (0.2 %) | 2 (0.3 %) | ns |
- Aborted sudden cardiac death | 8 (0.3 %) | 4 (0.2 %) | 1 (0.2 %) | ns |
- Stroke | 18 (0.5 %) | 10 (0.6 %) | 1 (0.2 %) | ns |
Costs of the different procedures and strategies
Sensitivity analysis
Statistics
Results
Demographics
Cost analysis
Costs CMR + CXA | Costs CXA + FFR | Costs CXA-only | % Cost reduction of CMR + CXA versus CXA + FFR | % Cost reduction of CMR + CXA versus CXA-only | % Cost reduction of CXA + FFR versus CXA-only | |
---|---|---|---|---|---|---|
German context (€) | ||||||
Main analysis (n = 3'647) | 932 | 1'090 | 2'298 | 14.5 | 59.4 | 52.6 |
Main analysis (n = 3'647) without rehab. & without cardiologist's visit | 919 | 1'082 | 2'290 | 15.1 | 59.9 | 52.8 |
- Atypical chest pain (n = 1'786) | 787 | 971 | 1'990 | 19.0 | 60.5 | 51.2 |
- Atypical chest pain (n = 1'786) without rehab. & without cardiologist's visit | 780 | 966 | 1'985 | 19.3 | 60.7 | 51.3 |
- Typical angina pectoris (n = 582) | 1'466 | 1'500 | 2'690 | 2.3 | 45.5 | 44.2 |
- Typical angina pectoris (n = 582) without rehab. & without cardiologist's visit | 1'456 | 1'514 | 2'704 | 3.8 | 46.2 | 44.0 |
UK context (£) | ||||||
Main analysis (n = 3'647) | 1'075 | 1'623 | 2'224 | 33.8 | 51.7 | 27.0 |
- Atypical chest pain (n = 1'786) | 968 | 1'552 | 2'052 | 37.6 | 52.8 | 24.4 |
- Typical angina pectoris (n = 582) | 1'513 | 1'866 | 2'444 | 18.9 | 38.1 | 23.7 |
Swiss context (CHF) | ||||||
Main analysis (n = 3'647) | 3'252 | 4'451 | 8'399 | 26.9 | 61.3 | 47.0 |
Main analysis (n = 3'647) without rehab. & without cardiologist's visit | 3'191 | 4'420 | 8'368 | 27.8 | 61.9 | 47.2 |
- Atypical chest pain (n = 1'786) | 2'783 | 4'044 | 7'520 | 31.2 | 63.0 | 46.2 |
- Atypical chest pain (n = 1'786) without rehab. & without cardiologist's visit | 2'733 | 4'017 | 7'493 | 32.0 | 63.5 | 46.4 |
- Typical angina pectoris (n = 582) | 5'074 | 5'816 | 9'511 | 12.8 | 46.7 | 38.9 |
- Typical angina pectoris (n = 582) without rehab. & without cardiologist's visit | 4'983 | 5'784 | 9'479 | 13.8 | 47.4 | 39.0 |
US context ($) | ||||||
Main analysis (n = 3'647) | 1'740 | 2'292 | 6'022 | 24.1 | 71.1 | 61.9 |
Main analysis (n = 3'647) with cardiologist's visit | 1'759 | 2'294 | 6'024 | 23.3 | 70.8 | 61.9 |
- Atypical chest pain (n = 1'786) | 1'429 | 1'996 | 5'588 | 28.4 | 74.4 | 64.3 |
- Atypical chest pain (n = 1'786) with cardiologist's visit | 1'444 | 1'997 | 5'589 | 27.7 | 74.2 | 64.3 |
- Typical angina pectoris (n = 582) | 2'947 | 3'335 | 6'592 | 11.6 | 55.3 | 49.4 |
- Typical angina pectoris (n = 582) with cardiologist's visit | 2'983 | 3'336 | 6'593 | 10.6 | 54.8 | 49.4 |