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IMPACT-CARD

The IMPACT-CARD (Investigation of a Molecular Personalized Coronary Gene Expression Test on Cardiology Practice Pattern) Trial

Purpose:

To measure the impact of the Corus CAD score on clinicians' care plans for patients presenting with chest pain or angina equivalent symptoms in the cardiology office.

Type:

Prospective

Size:

83 patients were eligible for analysis in the trial and matched with 83 historical controls with similar clinical factors.

Trial Design:

IMPACT-CARD1 was conducted in the cardiology department at Vanderbilt University Medical Center using a pre- and post-trial design. The clinicians performed their initial assessment of the patient and recorded their preliminary patient management plan into one of the following categories: (1) no intervention/medical management; (2) referral for coronary computed tomography angiography (CCTA) or stress testing with or without imaging, including myocardial perfusion imaging (MPI); or (3) referral for invasive coronary angiography. The clinicians then obtained a peripheral blood sample and ordered the Corus CAD test. After receiving the Corus CAD results, each clinician decided on the appropriate evaluation and management of the patient using the Corus CAD score in conjunction with the information that was previously available. We measured both the percentage of time that clinicians changed their care plans and whether the change resulted in an increase or decrease in the intensity of testing.

Key Findings:

Clinicians changed their care plan for 58% of the patients (48/83). There was an overall reduction in the intensity of testing across the patient population after clinicians received the Corus CAD scores. Low Corus CAD scores generally corresponded with less intensive cardiac diagnostic evaluation and management, while elevated scores generally corresponded with more intensive cardiac diagnostic evaluation and management.

Status:

Published, Critical Pathways in Cardiology (May 2013)1

Identifier:

NCT01251302

 

IMPACT-CARD Trial Results (n=83)

Clinicians Changed Patients' Care Plan 58% of the Time After Corus CAD Testing (p<0.001)

 

Patients With Downgraded Testing

Patients With No Change in Testing

Patients With Upgraded Testing

Corus CAD (≤15)

56%

(29/52)

44%

(23/52)

0%

(0/52)

Corus CAD (>15)

10%

(3/31)

39%

(12/31)

52%

(16/31)


  1. McPherson JA, Davis K, Yau M, et al. The Clinical Utility of Gene Expression Testing on the Diagnostic Evaluation of Patients Presenting to the Cardiologist With Symptoms of Suspected Obstructive Coronary Artery Disease: Results From the IMPACT (Investigation of a Molecular Personalized Coronary Gene Expression Test on Cardiology Practice Pattern) Trial. Crit Pathw Cardiol. 2013;12(2):37-42.