Abstract 268: The Use of Coronary Computed Tomography Angiography in Chest Pain Patients in the Emergency Departments Reduces Future Hospital Admissions and Does Not Impact The Need for Cardiac Catheterizations: A busting meta-analysis

Abstract

Background: Coronary Computed Tomography Angiography (CCTA) has been deemed appropriate to use in evaluating chest pain in the emergency department (ED). However, concerns remain regarding downstream resource utilization post CCTA. We performed a meta-analysis of existing studies to address whether there is an increase in downstream testing in patients undergoing CCTA vs. the standard of care. Methods: We performed a search of PubMed and Scopus databases from 1966 through October 2012. We evaluated the number of hospital readmissions and subsequent visits to the ED after the initial evaluation. In addition, we evaluated the total number of left heart cardiac catheterizations (CATH), and the need for late non-invasive tests. We used fixed effect analysis when the I 2 was up to 50% and the P at least 0.05, otherwise we used random effect. Results: Out of 2333 articles, 4 randomized controlled trials and 3 prospective studies with control groups were included in the analysis. Out of 4466 patients, 2508 underwent CCTA as the initial test and 1958 were assigned to standard of care (SOC) as defined by the investigators which included evaluation with stress testing. In patients evaluated with CCTA, there was a 36% reduction in the chance of future hospital admissions (OR: 0.64, 95%CI: 0.41-0.99; p=0.04) (Figure) and a trend towards fewer ED revisits (OR: 0.63, 95%CI: 0.38-1.07, p=0.09). The total CATH and late non-invasive testing utilization was similar among the groups (p=0.48 and 0.32). Conclusions: A meta-analysis of the existing literature suggests that the use of CCTA to evaluate chest pain in the ED results in a reduction in hospital readmissions and ED revisits without an increase in downstream testing.