Abstract
Coronary computed tomographic angiography (CCTA) can image the coronary vasculature rapidly and detect the presence and severity of luminal stenosis accurately. However, whether CCTA based care strategy could gain more benefits than conventional strategy with functional tests for patients with low-to-intermediate risk chest pain remains unknown. In this study we performed a meta-analysis to compare the clinical efficacy of CCTA versus conventional strategy. Eight randomized controlled trials with 14749 patients were finally included in this review after database searching. Compared with conventional strategy, CCTA significantly increased the rates of invasive coronary angiography (RR 1.44; 95% CI 1.28 to 1.63) and revascularization (RR 1.94; 95% CI 1.65 to 2.29), but did not change the rates of major adverse cardiovascular events (RR 1.10; 95% CI 0.92 to 1.30), death (RR 0.95; 95% CI 0.64 to 1.40) and hospital readmission (RR 0.96; 95% CI 0.66 to 1.40). Consequently, compared with conventional strategy, CCTA seemed not to improve clinical outcomes for patients with low-to-intermediate risk chest pain.
Highlights
Low-to-intermediate risk chest pain is a common clinical issue in emergency departments (ED) [1]
coronary computed tomographic angiography (CCTA) increased the rate of ICA, which may be because CCTA could increase the identification of coronary atherosclerosis, subsequently warranting to be validated by ICA
CCTA was associated with the higher rate of revascularization, which was closely related to the increased ICA rate
Summary
Low-to-intermediate risk chest pain is a common clinical issue in emergency departments (ED) [1]. Whether CCTA based care strategy could gain more clinical benefits than conventional care strategy with functional tests for patients with low-to-intermediate risk chest pain remains unknown. El-Hayek et al carried out a meta-analysis to show CCTA based care strategy reduced the risk of future adverse cardiovascular events and subsequent ED visits among patients with low-to-intermediate risk chest pain [7]. Their conclusions were inherently unreliable, because there was high heterogeneity among studies included in the meta-analysis. We carried out a meta-analysis to quantify the available clinical evidences on efficacy of CCTA versus conventional care strategy in patients with low-intermediate risk chest pain
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