Abstract 11855: Coronary Computed Tomography Angiography Increases Invasive Procedures Without Improving Clinical Outcomes in Patients With Suspected Acute Coronary Syndrome - A Meta-analysis of Randomized Controlled Trials
Introduction: Coronary computed tomography angiography (CCTA) is considered equal to other forms of noninvasive cardiac testing for low-to-intermediate risk patients with suspected ACS. Clinical trials comparing CCTA to standard care (SC) suggest that CCTA increases invasive coronary angiography (ICA) and revascularization procedures without reducing major adverse cardiac events (MACE), ED revisits, or follow up hospitalizations but were underpowered to detect differences in these endpoints. Given technological advances in CCTA and new trials comparing it to SC, we sought to ascertain the impact of CCTA on clinical outcomes in patients with suspected ACS and a nonischemic workup.
Methods: We performed a systematic search of PubMed and EMBASE for randomized controlled trials of CCTA compared to SC from January 2006 through April 2016 with a minimum of 100 patients and 28 days follow up. Studies were restricted to those which included patients with suspected ACS, who were either ED or inpatient status, and whose initial workup was negative for ischemia.
Results: Six randomized, controlled trials met our inclusion criteria and involved 2,397 patients undergoing CCTA and 1,834 undergoing SC. Patients who underwent CCTA were significantly more likely to undergo ICA (7.7% vs 5.3%; RR 1.6, p<0.001) and revascularization (4.3% vs 2.1%; RR 2.3, p<0.001). There was no difference in the incidence of death or MI following the index visit, post-discharge ED visits, or rehospitalizations (table).
Conclusions: CCTA compared to SC increases rates of ICA and revascularization in patients with suspected ACS and a negative workup but does not improve clinically relevant patient outcomes. CCTA may increase harm compared to SC by exposing patients to unnecessary downstream invasive procedures.
- Noninvasive cardiac imaging
- Acute coronary syndromes
- Evidence-based medicine
- Cardiac CT
- Comparative effectiveness
Author Disclosures: A.J. Foy: None. S. Dhruva: None. J.M. Mandrola: Honoraria; Modest; Medtronic. D.J. Morgan: None. R.F. Redberg: None.
- © 2016 by American Heart Association, Inc.