Journal article
Is Physiologic Stress Test with Imaging Comparable to Anatomic Examination of Coronary Arteries by Coronary Computed Tomography Angiography to Investigate Coronary Artery Disease? – A Systematic Review and Meta-Analysis
Curēus (Palo Alto, CA), v 12(2), pp e6941-e6941
10 Feb 2020
PMID: 32190493
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Objective
Coronary computed tomography angiography (CCTA) is a noninvasive diagnostic modality that remains underutilized compared to functional stress testing (ST) for investigating coronary artery disease (CAD). Several patients are misdiagnosed with noncardiac chest pain (CP) that eventually die from a cardiovascular event in subsequent years. We compared CCTA to ST to investigate CP.
Methods
We searched MEDLINE, PubMed, Cochrane Library, and Embase from January 1, 2007 to July 1, 2018 for randomized controlled trials (RCTs) comparing CCTA to ST in patients who presented with acute or stable CP. We used Review Manager (RevMan) [Computer program] Version 5.3 (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014) for review and analysis.
Results
We included 16 RCTs enrolling 21,210 patients; there were more patients with hyperlipidemia and older patients in the ST arm compared to the CCTA arm. There was no difference in mortality: 103 in the CCTA arm vs. 110 in the ST arm (risk ratio [RR] = 0.93, 95% confidence interval [CI] = 0.71-1.21, P = .58, and I
2
= 0%). A significant reduction was seen in myocardial infarctions (MIs) after CCTA compared to ST: 115 vs. 156 (RR = 0.71, CI = 0.56-0.91, P < .006, I
2
=0%). On subgroup analysis, the CCTA arm had fewer MIs vs. the ST with imaging subgroup (RR = 0.70, CI = 0.54-0.89, P = .004, I
2
= 0%) and stable CP subgroup (RR = 0.66, CI = 0.50-0.88, P = .004, I
2
= 0%). The CCTA arm showed significantly higher invasive coronary angiograms and revascularizations and significantly reduced follow-up testing and recurrent hospital visits. A trend towards increased unstable anginas was seen in the CCTA arm.
Conclusions
Our analysis showed a significant reduction in downstream MIs, hospital visits, and follow-up testing when CCTA is used to investigate CAD with no difference in mortality.
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Details
- Title
- Is Physiologic Stress Test with Imaging Comparable to Anatomic Examination of Coronary Arteries by Coronary Computed Tomography Angiography to Investigate Coronary Artery Disease? – A Systematic Review and Meta-Analysis
- Creators
- Waqas J Siddiqui - Drexel UniversityMuhammad Shabbir Rawala - Charleston Area Medical CenterWaqas Abid - Christiana HospitalMuhammad Zain - Shaikh Zayed Medical College and HospitalMurrium I Sadaf - Yale UniversityDanish Abbasi - University of Arkansas at Little RockChikezie Alvarez - St. Francis Medical CenterFarah Mansoor - Dow University of Health SciencesSyed Farhan Hasni - Einstein Medical Center PhiladelphiaSandeep Aggarwal - University of Pennsylvania
- Publication Details
- Curēus (Palo Alto, CA), v 12(2), pp e6941-e6941
- Publisher
- Cureus
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Nephrology (and Hypertension)
- Web of Science ID
- WOS:000513502900014
- Other Identifier
- 991019318935904721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Cardiac & Cardiovascular Systems