Abstract 11405: Non-Invasive Assessment of Chest Pain in the Emergency Department: A Meta-Analysis of Prospective Trials
Background: Chest pain is one of the most common ED admission diagnoses. Different non-invasive imaging modalities have been proposed. However, the best test to evaluate chest pain in the ED has not yet been determined.
Objective: To evaluate the diagnostic accuracy of cardiac computed tomographic angiography (CCTA), stress echocardiography (SE) and single photon emission computed tomography (SPECT) for the assessment of chest pain in the ED.
Methods: A systematic review of Medline, Cochrane, and Embase was done to identify prospective clinical trials assessing chest pain in the ED using CCTA, SE and SPECT. Standard approach and bivariate analysis were performed.
Results: A total of 37 studies with 7800 patients fulfilled the inclusion criteria. A total of 15 studies used CCTA, 9 studies used SE, and 13 studies used SPECT. The sensitivity and specificity for CCTA were 95% and 99%, respectively, whereas the PPV was 84% and NPV was 100%. SE revealed a sensitivity and specificity of 84% and 94%, respectively, whereas the PPV was 73% and NPV was 96%. Finally, SPECT had a sensitivity, specificity, PPV and NPV of 85%, 86%, 57% and 95% correspondingly. There was no difference in NPV among tests. CCTA demonstrated to be superior to SE and SPECT providing the highest sensitivity, specificity, and PPV.
Conclusion: CCTA is a reliable non-invasive imaging modality for the assessment of ACS in the ED and it is significantly more accurate than SE and SPECT.
Figure. HSROC curves. Hierarchical summary receiver operating characteristic (HSROC) plots of A) CTTA, B) SE and C) SPECT vs Angiography/MACE) to assess CAD. Based on combined sensitivity and specificity weighted for sample size of each data set reflected by the size of the circles, showing average sensitivity and specificity estimate of the study results (solid square) and 95% confidence region around it. The 95% prediction region represents the confidence region for a forecast of the true sensitivity and specificity in a future study.
- © 2013 by American Heart Association, Inc.