In-Hospital Cost Comparison of Triple-Rule-Out Computed Tomography Angiography Versus Standard of Care in Patients With Acute Chest Pain

J Thorac Imaging. 2020 May;35(3):198-203. doi: 10.1097/RTI.0000000000000474.


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.

Publication types

  • Comparative Study

MeSH terms

  • Acute Pain / cerebrospinal fluid
  • Acute Pain / diagnostic imaging
  • Acute Pain / economics
  • Acute Pain / etiology
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Chest Pain / diagnostic imaging
  • Chest Pain / economics*
  • Chest Pain / etiology
  • Computed Tomography Angiography / economics*
  • Computed Tomography Angiography / statistics & numerical data
  • Coronary Angiography / economics*
  • Coronary Angiography / statistics & numerical data
  • Coronary Artery Disease / complications*
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / economics
  • Costs and Cost Analysis / economics
  • Costs and Cost Analysis / methods*
  • Costs and Cost Analysis / statistics & numerical data
  • Female
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Standard of Care / economics*
  • Standard of Care / statistics & numerical data
  • Young Adult