Acute chest pain evaluation using coronary computed tomography angiography compared with standard of care: a meta-analysis of randomised clinical trials

Góngora, Carlos; Bavishi, Chirag; Uretsky, Seth; Argulian, Edgar

doi:10.1136/heartjnl-2017-311647

Cited by 29 publications

(26 citation statements)

References 30 publications

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“…There is now increasing evidence to support the use of CCTA over functional ischemia testing in patients with stable chest pain ( 32 , 33 ). Recent trials demonstrated that CCTA clarified the diagnosis of CAD and led to major improvements in patient outcomes by increasing the use of evidence-based preventative therapies ( 34 ).…”

Section: Discussionmentioning

confidence: 99%

Troponin-Guided Coronary Computed Tomographic Angiography After Exclusion of Myocardial Infarction

Lee¹,

Bularga²,

O’Brien³

et al. 2021

Journal of the American College of Cardiology

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Background Patients with suspected acute coronary syndrome in whom myocardial infarction has been excluded are at risk of future adverse cardiac events. Objectives This study evaluated the usefulness of high-sensitivity cardiac troponin I (hs-cTnI) to select patients for further investigation after myocardial infarction has been excluded. Methods This is a prospective cohort study of patients presenting to the emergency department with suspected acute coronary syndrome and hs-cTnI concentrations below the sex-specific 99th percentile. Patients were recruited in a 2:1 fashion, stratified by peak hs-cTnI concentration above and below the risk stratification threshold of 5 ng/L. All patients underwent coronary computed tomography angiography (CCTA) after hospital discharge. Results Overall, 250 patients were recruited (61.4 ± 12.2 years 31% women) in whom 62.4% (156 of 250 patients) had coronary artery disease (CAD). Patients with intermediate hs-cTnI concentrations (between 5 ng/L and the sex-specific 99th percentile) were more likely to have CAD than those with hs-cTnI concentrations <5 ng/L (71.9% [120 of 167 patients] vs 43.4% [36 of 83 patients]; odds ratio: 3.33; 95% CI: 1.92-5.78). Conversely, there was no association between anginal symptoms and CAD (63.2% [67 of 106 patients] vs 61.8% [89 of 144 patients]; odds ratio: 0.92; 95% CI: 0.48-1.76). Most patients with CAD did not have a previous diagnosis (53.2%; 83 of 156 patients) and were not on antiplatelet and statin therapies (63.5%; 99 of 156 patients) before they underwent CCTA. Conclusions In patients who had myocardial infarction excluded, CAD was 3× more likely in those with intermediate hs-cTnI concentrations compared with low hs-cTnI concentrations. In such patients, CCTA could help to identify those with occult CAD and to target preventative treatments, thereby improving clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Troponin-Guided Coronary Computed Tomographic Angiography After Exclusion of Myocardial Infarction

Lee¹,

Bularga²,

O’Brien³

et al. 2021

Journal of the American College of Cardiology

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“…The authors undertook a meta-analysis of RCTs published prior to March 2017 comparing CTCA with standard care in the assessment of patients with acute chest pain 1. Standard care varied across the trials but always incorporated non-invasive functional testing—that is, exercise ECG, stress echocardiography or myocardial perfusion imaging.…”

Section: Methodsmentioning

confidence: 99%

CT coronary angiography does not reduce mortality or myocardial infarction in low-risk patients with acute chest pain

Adamson

Than

2018

BMJ EBM

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“…They have also shown that CCTA is associated with reduced time to-diagnosis, reduced length of hospital stay and reduced cost 35 , 36 . However, a meta-analysis of the randomized controlled trials in patients with acute chest pain found that there was no difference in the outcomes of all-cause mortality, myocardial infarction or major adverse cardiac events between the CCTA and standard care groups 37 Table 2Randomized controlled trials of CCTA improving outcomes in acute chest pain 35 , 36 , 66 , 67 .ACRIN-PABEACONCATCHCT-COMPARECT-STATNabi et alPERFECTPROSPECTROMICAT-IINumber of patients13684905765626995983954001000CCTA vsStress ECG, stress imagingStress ECG, MPIStress ECG, MPIStress ECGMPIMPIStress echo., MPIMPIStress ECG, Stress echo., MPIAge (mean years)505456525053605754Female (%)544745425456546347Follow-up (months)12119126712121ACRIN-PA, CT Angiography for Safe Discharge of Patients with Possible Acute Coronary Syndromes; BEACON, Better Evaluation of Acute Chest Pain with Coronary Computed Tomography Angiography; CATCH, CArdiac cT in the treatment of acute CHest pain; CT-COMPARE, CT Coronary Angiography Compared to Exercise ECG; CT-STAT, Coronary Computed Tomographic Angiography for Systematic Triage of Acute Chest Pain Patients to Treatment; PERFECT, Prospective Firs...…”

Section: Ccta and Outcomes In Patients With Acute Chest Painmentioning

confidence: 99%

Coronary atherosclerosis imaging by CT to improve clinical outcomes

Williams

Newby

Nicol

2019

Journal of Cardiovascular Computed Tomography

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Coronary artery disease remains an important cause of morbidity and mortality worldwide. Coronary Computed Tomography Angiography (CCTA) has excellent diagnostic accuracy and the identification and stratification of coronary artery disease is associated with improved prognosis in multiple studies. Recent randomized controlled trials have shown that in patients with stable coronary artery disease, CCTA is associated with improved diagnosis, changes in investigations, changes in medical treatment and appropriate selection for revascularization. Importantly this diagnostic approach reduces the long-term risk of fatal and non-fatal myocardial infarction. The identification of adverse plaques on CCTA is known to be associated with an increased risk of acute coronary syndrome, but does not appear to be predictive of long-term outcomes independent of coronary artery calcium burden. Future research will involve the assessment of outcomes after CCTA in patients with acute chest pain and asymptomatic patients. In addition, more advanced quantification of plaque subtypes, vascular inflammation and coronary flow dynamics may identify further patients at increased risk.

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Acute chest pain evaluation using coronary computed tomography angiography compared with standard of care: a meta-analysis of randomised clinical trials

Abstract: 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.

Cited by 29 publications

References 30 publications

Troponin-Guided Coronary Computed Tomographic Angiography After Exclusion of Myocardial Infarction

Troponin-Guided Coronary Computed Tomographic Angiography After Exclusion of Myocardial Infarction

CT coronary angiography does not reduce mortality or myocardial infarction in low-risk patients with acute chest pain

Coronary atherosclerosis imaging by CT to improve clinical outcomes

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