Abstract
Background: The coronary computed tomography angiography (CCTA) is a noninvasive alternative tool in diagnosis of coronary artery disease compared to invasive coronary angiography (ICA). However, there is uncertainty regarding its usefulness in reducing major adverse cardiovascular events in stable chest pain patients. Methods: We have searched EMBASE, PubMed, and Cochrane Library (inception through May 24 th , 2022) for randomized controlled trials (RCTs) evaluating CCTA versus ICA in stable chest pain. The Mantel-Haenszel method was used with Paule-Mandel estimator of tau 2 and Hartung-Knapp-Sidik-Jonkman adjustment (given small number of the included studies) to calculate the risk ratio (RR) and 95% confidence interval (CI). Results: Three RCTs with a total of 5,393 patients were included in this study. There was no significant difference between CCTA and ICA in terms of myocardial infarction [RR: 1.12; 95%CI: 0.60; 2.09; I 2 :0%] [Figure ], stroke [RR: 0.52; 95%CI: 0.22; 1.24; I 2 :0%], all-cause mortality [RR: 1.83; 95%CI: 0.17; 20.18; I 2 :50%], or cardiovascular mortality [RR: 0.47; 95%CI: 0.02; 9.15; I 2 :0%]. Conclusion: This meta-analysis suggests that there is no difference between CCTA and ICA for stable chest pain evaluation in terms of myocardial infarction, stroke, all-cause mortality, or cardiovascular mortality.
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