RT Journal Article
SR Electronic
T1 Acute chest pain evaluation using coronary computed tomography angiography compared with standard of care: a meta-analysis of randomised clinical trials
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 215
OP 221
DO 10.1136/heartjnl-2017-311647
VO 104
IS 3
A1 Carlos A Gongora
A1 Chirag Bavishi
A1 Seth Uretsky
A1 Edgar Argulian
YR 2018
UL http://heart.bmj.com/content/104/3/215.abstract
AB 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.