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Coronary Computed Tomography Angiography for the Work up of Chest Pain Reduces the Follow up Incidence of Myocardial Infarction a Systematic Review and Meta-Analysis of Sixteen Randomized Control Trials
Journal article

Coronary Computed Tomography Angiography for the Work up of Chest Pain Reduces the Follow up Incidence of Myocardial Infarction a Systematic Review and Meta-Analysis of Sixteen Randomized Control Trials

Waqas Siddiqui, Muhammad Rawala, Waqas Abid, Chikezie Alvarez, Muhammad Hanif, Farah Mansoor, Syed Hasni, Sandeep Aggarwal and Howard Eisen
Circulation (New York, N.Y.), v 138(Suppl 1), pp A11609-11609
06 Nov 2018

Abstract

Background Coronary Artery disease is the leading cause of death. Its workup is performed annually in > 20 million patients worldwide. Several patients are misdiagnosed with non-cardiac chest pains and eventually die from a cardiovascular event in the subsequent follow-up within five years. We performed this meta-analysis to compare the efficacy of Coronary Computed Tomography Angiography (CCTA) to non-invasive testing (NIT) with and without imaging in the workup of acute and stable chest pain. Methods and Results We searched PubMed and Medline from from January 01, 2007 until January 01, 2018, for Randomized Control Trials (RCTs) comparing CCTA to NIT in patients who presented with acute or stable chest pain. We included sixteen RCTs enrolling 21,199 patients. We used RevMan Version 5.3 Copenhagen for review and analysis. CCTA was associated with significant reduction in Myocardial Infarctions (MI), 115vs.156, Risk Ratio (RR)=0.71, 95% Confidence Interval (CI)=0.56-0.91, p<0.006, I=0%, with no difference in mortality, RR=.93, CI=0.71-1.21, p=58, I=0%. This difference was driven by the decreased incidence of MIs in the stable chest pain subgroup, 80vs.120, RR=0.66, CI=0.50-0.88, p=0.004, I=0%, as compared to acute chest pain subgroup, where there was no statistical difference in the incidence of MI in either arm, 35vs.36, RR=0.88, CI=0.54-1.44, p=0.54, I=0%. There were significantly more true positive invasive coronary angiograms (ICA) and revascularization with significantly reduced follow-up testing and recurrent hospital visits after CCTA. There was significantly higher exposure to radiation with an increasing trend of unstable anginas after CCTA.ConclusionsThis analysis demonstrates a significantly reduced MIs, recurrent hospital visits and downstream follow-up testing after CCTA with no difference in mortality.

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