Trial reportAnnals of emergency medicine2010
Stress cardiac magnetic resonance imaging with observation unit care reduces cost for patients with emergent chest pain: a randomized trial.
Trial report in Annals of emergency medicine, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 37 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Efficacy Evaluation of the HEART Pathway in Emergency Department Patients With Acute Chest Pain
Cardiac Magnetic Resonance Imaging Strategy for the Management of Patients With Acute Chest Pain and Detectable to Elevated Troponin
The HEART Pathway: Bridging the Gap Between Operations, Research, and Education
Who cites it
37 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Outcomes of emergency department observation units for geriatric assessment: a systematic review and meta-analysis.Singapore medical journal · 2026Pooled it
- Hospitalisation in short-stay units for adults with internal medicine diseases and conditions.The Cochrane database of systematic reviews · 2018Pooled it
- Outcomes of non-invasive diagnostic modalities for the detection of coronary artery disease: network meta-analysis of diagnostic randomised controlled trials.BMJ (Clinical research ed.) · 2018Pooled it
- Cardiac Magnetic Resonance Imaging Versus Invasive-Based Strategies in Patients With Chest Pain and Detectable to Mildly Elevated Serum Troponin: A Randomized Clinical Trial.Circulation. Cardiovascular imaging · 2023Trial
- ACES (Accelerated Chest Pain Evaluation With Stress Imaging) Protocols Eliminate Testing Disparities in Patients With Chest Pain.Critical pathways in cardiology · 2019Trial
- Stress CMR reduces revascularization, hospital readmission, and recurrent cardiac testing in intermediate-risk patients with acute chest pain.JACC. Cardiovascular imaging · 2013Trial
- Superior diagnostic performance of perfusion-cardiovascular magnetic resonance versus SPECT to detect coronary artery disease: The secondary endpoints of the multicenter multivendor MR-IMPACT II (Magnetic Resonance Imaging for Myocardial Perfusion Assessment in Coronary Artery Disease Trial).Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance · 2012Trial
- Provider-directed imaging stress testing reduces health care expenditures in lower-risk chest pain patients presenting to the emergency department.Circulation. Cardiovascular imaging · 2012Trial
- Stress CMR imaging observation unit in the emergency department reduces 1-year medical care costs in patients with acute chest pain: a randomized study for comparison with inpatient care.JACC. Cardiovascular imaging · 2011Trial
- State of the Art: Observation Units in the Emergency Department, an Interim Practice Update and Policy Review.Journal of the American College of Emergency Physicians open · 2026Article
- Appropriateness of Cardiovascular Imaging in the Initial Assessment of Possible Acute Coronary Syndrome in the Emergency Department.Reviews in cardiovascular medicine · 2022Review
- Observation unit use among patients with cancer following emergency department visits: Results of a multicenter prospective cohort from CONCERN.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2022Article
- Monocyte Chemoattractant Protein-1 as a Predictor of Coronary Atherosclerosis in Patients Receiving Coronary Angiography.Critical pathways in cardiology · 2018Article
- Achieving the earliest possible reperfusion in patients with acute coronary syndrome: a current overview.Journal of intensive care · 2018Review
- Chest pain triage: Current trends in the emergency departments in the United States.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2017Review
- Cardiac magnetic resonance assessment of diastolic dysfunction in acute coronary syndrome.The Journal of international medical research · 2017Review
- Hospitalisation in an emergency department short-stay unit compared to an internal medicine department is associated with fewer complications in older patients - an observational study.Scandinavian journal of trauma, resuscitation and emergency medicine · 2017Observational
- Non-invasive assessment of low- and intermediate-risk patients with chest pain.Trends in cardiovascular medicine · 2017Review
- Cost analysis of the History, ECG, Age, Risk factors, and initial Troponin (HEART) Pathway randomized control trial.The American journal of emergency medicine · 2017Article
- HEART Pathway Accelerated Diagnostic Protocol Implementation: Prospective Pre-Post Interrupted Time Series Design and Methods.JMIR research protocols · 2016Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
11 authors.
Funding
Abstract
STUDY
objectiveWe determine whether imaging with cardiac magnetic resonance imaging (MRI) in an observation unit would reduce medical costs among patients with emergent non-low-risk chest pain who otherwise would be managed with an inpatient care strategy.
methodsEmergency department patients (n=110) at intermediate or high probability for acute coronary syndrome without electrocardiographic or biomarker evidence of a myocardial infarction provided consent and were randomized to stress cardiac MRI in an observation unit versus standard inpatient care. The primary outcome was direct hospital cost calculated as the sum of hospital and provider costs. Estimated median cost differences (Hodges-Lehmann) and distribution-free 95% confidence intervals (Moses) were used to compare groups.
resultsThere were 110 participants with 53 randomized to cardiac MRI and 57 to inpatient care; 8 of 110 (7%) experienced acute coronary syndrome. In the MRI pathway, 49 of 53 underwent stress cardiac MRI, 11 of 53 were admitted, 1 left against medical advice, 41 were discharged, and 2 had acute coronary syndrome. In the inpatient care pathway, 39 of 57 patients initially received stress testing, 54 of 57 were admitted, 3 left against medical advice, and 6 had acute coronary syndrome. At 30 days, no subjects in either group experienced acute coronary syndrome after discharge. The cardiac MRI group had a reduced median hospitalization cost (Hodges-Lehmann estimate $588; 95% confidence interval $336 to $811); 79% were managed without hospital admission.
conclusionCompared with inpatient care, an observation unit strategy involving stress cardiac MRI reduced incident cost without any cases of missed acute coronary syndrome in patients with emergent chest pain.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.