Clinical Outcomes After Evaluation of Stable Chest Pain by Coronary Computed Tomographic Angiography Versus Usual Care
Key result
Initial investigation of suspected stable coronary artery disease using coronary CTA significantly reduced myocardial infarction compared to usual care (rate ratio 0.69; 95% CI 0.49-0.98; P=0.038).
Why the study?
Does coronary CTA reduce myocardial infarction and all-cause mortality compared to usual care in patients with suspected stable coronary artery disease?
Population
14,817 patients with suspected stable coronary artery disease/stable chest pain
Comparison
Coronary computed tomographic angiography (CTA) vs Usual care with various functional testing…
Design
Meta-analysis
Authors
Discussion
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Member takes
Implication
Supports CTA-first strategy in suspected stable CAD; reinforces randomized evidence for MI reduction.
Study Design
Type
Meta-Analysis (n=14,817)
Multicenter
Yes
Structured PICO
Does coronary CTA reduce myocardial infarction and all-cause mortality compared to usual care in patients with suspected stable coronary artery disease?
P
Population
14,817 patients with suspected stable coronary artery disease from 4 randomized clinical trials comparing coronary CTA with usual care.
I
Intervention
Coronary computed tomographic angiography (CTA)
C
Comparator
Usual care with various functional testing approaches
O
Outcome
Myocardial infarction and all-cause mortalityhard clinical
Main Result
Relative Risk: 0.69 (95% CI 0.49–0.98)
p-value: p=0.038
In patients with suspected stable CAD, initial evaluation with coronary CTA reduces the rate of myocardial infarction compared to usual care, though it increases the incidence of coronary revascularization without affecting all-cause mortality.
Limitations
- Significant heterogeneity for invasive coronary angiography and revascularization was noted, which was attributable to the SCOT-HEART study.
- Significant heterogeneity for invasive coronary angiography and revascularization attributable to the SCOT-HEART study
Cite This Study
Bittencourt et al. (2016) conducted a meta-analysis in suspected stable coronary artery disease (n=14,817). Coronary computed tomographic angiography (CTA) vs. Usual care was evaluated on Myocardial infarction and all-cause mortality (rate ratio 0.69, 95% CI 0.49-0.98, p=0.038). Initial investigation of suspected stable coronary artery disease using coronary CTA significantly reduced myocardial infarction compared to usual care (rate ratio 0.69; 95% CI 0.49-0.98; P=0.038).