Evidence map›Paper›PMID 39908686›Full record

Trial reportThe American journal of emergency medicine2025

Cardiac testing choices by physician specialty in the CMR-IMPACT trial.

Michael W Supples, Anna C Snavely, Nicklaus P Ashburn, Lauren E Koehler, Jason P Stopyra, Carolyn J Park, Sujethra Vasu, Michael Kutcher, Gregory Hundley, Simon A Mahler and 2 more

Abstract readRandomized Controlled TrialMulticenter Study
In one paragraph

Trial report in The American journal of emergency medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Trial
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Michael W SupplesDepartment of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: mwsupple@wakehealth.edu.
Anna C SnavelyDepartment of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Nicklaus P AshburnDepartment of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA; Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America.
Lauren E KoehlerDepartment of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Jason P StopyraDepartment of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Carolyn J ParkSection on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America.
Sujethra VasuSection on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America.
Michael KutcherSection on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America.
Gregory HundleyDivision of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA.
Simon A MahlerDepartment of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Chadwick MillerDepartment of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
CMR-IMPACT Research Group

Funding

Wake Forest Clinical and Translational Science AwardKL2TR001421 · NCATS · WAKE FOREST UNIVERSITY HEALTH SCIENCES · PI MILLER, DAVID P · 2015 to 2023
$5.8M
CMR-IMPACTR01HL118263 · NHLBI · WAKE FOREST UNIVERSITY HEALTH SCIENCES · PI MILLER, CHADWICK DAVID · 2013 to 2018
$3.7M
Wake Forest Clinical Center for the NHLBI PETAL NetworkU01HL123027 · NHLBI · WAKE FOREST UNIVERSITY HEALTH SCIENCES · PI FILES, DANIEL CLARK, MILLER, CHADWICK DAVID · 2014 to 2020
$1.8M
Initiating Preventive Care for Hyperlipidemia in the Emergency Department: The EMERALD TrialK23HL169929 · NHLBI · WAKE FOREST UNIVERSITY HEALTH SCIENCES · PI Nicklaus P Ashburn · 2024 to 2026
$468k
AHRQ HHS R01 HS029017AHRQ HHS R21 HS029234NCATS NIH HHS KL2 TR001421NHLBI NIH HHS K23 HL169929NHLBI NIH HHS R01 HL118263NHLBI NIH HHS U01 HL123027
6 · The paper itself

Abstract

backgroundHeterogeneity is observed in the care of patients with chest pain. We investigate the association of physician specialty and diagnostic testing among patients admitted for suspected acute coronary syndrome (ACS).

methodsThis is a secondary analysis of the CMR-IMPACT multicenter randomized controlled trial in which patients with suspected ACS were admitted and randomized to undergo invasive angiography or non-invasive CMR stress imaging. Admitting physician was dichotomized to interventional cardiologist (IC) or not (e.g. hospitalist). We describe adherence to protocol and angiography during the index visit by treatment arm and admitting physician specialty. A generalized estimating equation accounting for clustering within physician was used to evaluate significance and adjusted for randomization arm.

resultsThe 258 enrolled patients from 2013 to 2018 had a mean age of 60.7 (SD ± 10.9) years, 40.3 % (104/258 were female), and 64.7 % (167/258) were white race. ICs were the admitting physicians for 50.4 % (130/258) of the patients. Index angiography was performed more often among patients admitted by IC versus other physicians, 65.4 % (85/130) versus 53.1 % (68/128), respectively; aOR 1.75 (95 % CI 1.14-2.68). Among patients randomized to an invasive strategy, higher protocol adherence was observed in those admitted by IC [85.3 % (58/68)] versus other physicians [64.5 % (40/62)]; OR 2.82 (95 % CI 1.08-7.38). For patients randomized to the CMR-based strategy, adherence to protocol was similar for IC [67.7 % (42/62)] and other physicians [66.7 % (44/66)]; OR 0.82 (95 % CI 0.35-1.94).

conclusionInvasive angiography was more frequent among patients admitted by interventional cardiologists compared to other physicians.

Indexed as

Acute Coronary SyndromeCardiologistsCoronary AngiographyPractice Patterns, Physicians'AgedChest PainFemaleHumansMaleMiddle AgedAcute coronary syndromeAngiographyCardiac magnetic resonanceChest pain

Identifiers

PMID39908686
PMCPMC12273696

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Registered trials

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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.