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Original research article
Acute chest pain evaluation using coronary computed tomography angiography compared with standard of care: a meta-analysis of randomised clinical trials
  1. Carlos A Gongora1,
  2. Chirag Bavishi1,
  3. Seth Uretsky2,
  4. Edgar Argulian1
  1. 1 Mount Sinai Heart, Mount Sinai St Luke’s Hospital, Icahn School of Medicine, New York, USA
  2. 2 Department of Cardiovascular Medicine, Morristown Medical Center, Gagnon Cardiovascular Institute, Morristown, New Jersey, USA
  1. Correspondence to Dr Edgar Argulian, Division of Cardiology, Mount Sinai St. Luke’s Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10019, USA; eargulian{at}, edgar.argulian{at}


Objective Coronary CT angiography (CCTA) has certain advantages compared with stress testing including greater accuracy in identifying obstructive coronary disease. The aim of the study was to perform a systematical review and meta-analysis comparing CCTA with other standard-of-care (SOC) approaches in evaluation of patients with acute chest pain.

Methods Electronic databases were systematically searched to identify randomised clinical trials of patients with acute chest pain comparing CCTA with SOC approaches. We examined the following end points: mortality, major adverse cardiac events (MACE), myocardial infarction (MI), invasive coronary angiography (ICA) and revascularisation. Pooled risk ratios (RR) and their 95% CIs were calculated using random-effects models.

Results Ten trials with 6285 patients were included. The trials used different definitions and implementation for SOC but all used physiologic testing. The clinical follow-up ranged from 1 to 19 months. There were no significant differences in all-cause mortality (RR 0.48, 95% CI 0.17 to 1.36, p=0.17), MI (RR 0.82, 95% CI 0.49 to 1.39, p=0.47) or MACE (RR 0.98, 95% CI 0.67 to 1.43, p=0.92) between the groups. However, significantly higher rates of ICA (RR 1.32, 95% CI 1.07 to 1.63, p=0.01) and revascularisation (RR 1.77, 95% CI 1.35 to 2.31, p<0.0001) were observed in the CCTA arm.

Conclusions Compared with other SOC approaches use of CCTA is associated with similar major adverse cardiac events but higher rates of revascularisation in patients with acute chest pain.

  • cardiac computer tomographic (ct) imaging
  • standard of care
  • major adverse cardiac events
  • invasive coronary angiography
  • myocardial infarction

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  • Contributors CG contributed with data extraction, analysis, interpretation and drafting. CB contributed with data extraction, analysis and interpretation. SU contributed with drafting of the manuscript and revising it critically for important intellectual content. EA contributed with interpretation of data as well as drafting of the manuscript and revising it critically for important intellectual content. All authors approve the final version of the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement This is a meta-analysis of randomised clinical trials. The data information for this paper is widely available to people with access to the information in each journal.