Comparing Coronary Computed Tomography Angiography to Single-photon Emission Computed Tomography in the Evaluation of Chest Pain in the Emergency Department

Division

North Florida

Hospital

North Florida Regional Medical Center

Document Type

Manuscript

Publication Date

8-14-2026

Disciplines

Cardiology | Cardiovascular Diseases | Diagnosis | Internal Medicine | Medicine and Health Sciences

Abstract

BACKGROUND: Coronary computed tomography angiography (CCTA) is an alternative to single-photon emission computed tomography (SPECT) for evaluating intermediate-risk chest pain in the emergency department, offering rapid assessment and potentially less unnecessary invasive testing. Despite guideline support, real-world comparative data remain limited.

METHODS: We retrospectively studied adults presenting with chest pain or angina-equivalent symptoms to emergency departments within the HCA Healthcare (United States) from January 2017 to June 2024 who underwent CCTA or SPECT at the index encounter. The primary outcome was invasive coronary angiography (ICA) during the index hospitalization. Secondary outcomes were length of stay (LOS), 30-, 60-, and 90-day all-cause readmissions, in-hospital mortality, and renal replacement therapy (RRT). Regression models adjusted for age, sex, diabetes, hypertension, and hyperlipidemia.

RESULTS: Among 22,195 patients, 2827 (12.7%) underwent CCTA and 19,368 (87.3%) SPECT. ICA occurred in 15.2% of CCTA versus 24.6% of SPECT patients (adjusted odds ratio [OR] 1.75 for SPECT vs CCTA, 95% confidence interval [CI] 1.56-1.95; p < 0.0001). LOS and readmissions did not differ significantly, but RRT was more frequent with SPECT (OR 2.28, 95% CI 1.44-3.62; p = 0.0004). In-hospital mortality was rare; mortality comparison was underpowered.

CONCLUSION: In this multicenter cohort, CCTA was associated with lower downstream ICA utilization and lower RRT incidence than SPECT, without extending LOS or increasing readmissions. These associations are directionally consistent with the 2021 AHA/ACC Chest Pain Guidelines. Given substantial baseline imbalance between cohorts and likely residual confounding, the findings are hypothesis-generating and require prospective validation before informing practice.

Publisher or Conference

Journal of Cardiovascular Computed Tomography

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