Chest pain, one of the most frequent symptoms that physicians encounter, is a symptom that warns of potentially dangerous myocardial ischemia and therefore warrants the highest diagnostic attention. Several noninvasive testing are utilized to determine which patients who present with chest pain have significant myocardial ischemia and which patients require invasive procedures. The emergence of coronary computed tomography angiography (CCTA) produced a substantial shift in diagnostic strategy for patients with suspected coronary artery disease (CAD), based on the diagnostic performance of CCTA and short-term outcomes following the test, relative to functional tests. Clinicians have rapidly adopted these noninvasive imaging studies for evaluation of patients with chest pain. This, in turn, has lead to the ever-increasing health-related cost spent in the evaluation of chest pain, necessitating the comparison of cost-effectiveness between each imaging modalities. Studies on this issue, whether by modeling or by retrospective analysis, has demonstrated that CCTA may be more cost-effective than myocardial single photon emission computed tomography (SPECT). However, the cost-effectiveness of these imaging studies has never been compared in a prospective, randomized clinical trial. In this trial, we compared the cost-effectiveness between CCTA and myocardial SPECT, the most widely used noninvasive imaging modality currently, in patients with intermediate risk chest pain.

This study aimed to compare the cost-effectiveness of the two most widely used noninvasive imaging test for evaluation of chest pain, coronary computed tomography angiography (CCTA) or myocardial single photon emission computed tomography (SPECT).