Assessment of chest pain patients remains a clinical challenge in the emergency department (ED). Several randomized controlled trials (RCTs) have shown the additive value of coronary computed tomographic angiography (CCTA) compared with standard care. Not all of them, however, had enough power to detect differences in clinical outcomes like revascularization. Therefore, we performed a meta-analysis to test the safety and efficacy of this non-invasive diagnostic approach in low- and intermediate-risk chest pain patients. MEDLINE/PubMed was systematically screened for RCTs comparing CCTA and non-CCTA approaches for ED patients presenting with chest pain. Baseline features, diagnostic strategies, and outcome data were appraised and pooled with random-effect methods computing summary estimates [95 confidence intervals (CIs)]. A total of four RCT studies including 2567 patients were identified, with similar inclusion and exclusion criteria. Patients in the CCTA group were more likely to undergo percutaneous or surgical revascularization during their index visit, with an odd ratio of 1.88 (1.212.92). Time to diagnosis was reduced with CCTA (7.68 h;12.70 to 2.66) along with costs of care in the ED ($680; 1.060 to 270: all CI 95). The present meta-analysis shows that a strategy with CCTA used as first imaging test for low- and intermediate-risk patients presenting to the ED with chest pain appears safe and seems not to increase subsequent invasive coronary angiographies. The approach is cost-effective although limited data and incomplete cost analyses have been performed. CCTA increases coronary revascularizations, with still an unknown effect on prognosis, especially in the long term.

Coronary computed tomographic angiography for detection of coronary artery disease in patients presenting to the emergency department with chest pain: a meta-analysis of randomized clinical trials / F., D'Ascenzo; E., Cerrato; BIONDI ZOCCAI, Giuseppe; P., Omede; F., Sciuto; D. g., Presutti; G., Quadri; G. l., Raff; J. a., Goldstein; H., Litt; Frati, Giacomo; M. j., Reed; C., Moretti; F., Gaita. - In: EUROPEAN HEART JOURNAL. CARDIOVASCULAR IMAGING. - ISSN 2047-2404. - STAMPA. - 14:8(2013), pp. 782-789. [10.1093/ehjci/jes287]

Coronary computed tomographic angiography for detection of coronary artery disease in patients presenting to the emergency department with chest pain: a meta-analysis of randomized clinical trials

BIONDI ZOCCAI, GIUSEPPE;FRATI, GIACOMO;
2013

Abstract

Assessment of chest pain patients remains a clinical challenge in the emergency department (ED). Several randomized controlled trials (RCTs) have shown the additive value of coronary computed tomographic angiography (CCTA) compared with standard care. Not all of them, however, had enough power to detect differences in clinical outcomes like revascularization. Therefore, we performed a meta-analysis to test the safety and efficacy of this non-invasive diagnostic approach in low- and intermediate-risk chest pain patients. MEDLINE/PubMed was systematically screened for RCTs comparing CCTA and non-CCTA approaches for ED patients presenting with chest pain. Baseline features, diagnostic strategies, and outcome data were appraised and pooled with random-effect methods computing summary estimates [95 confidence intervals (CIs)]. A total of four RCT studies including 2567 patients were identified, with similar inclusion and exclusion criteria. Patients in the CCTA group were more likely to undergo percutaneous or surgical revascularization during their index visit, with an odd ratio of 1.88 (1.212.92). Time to diagnosis was reduced with CCTA (7.68 h;12.70 to 2.66) along with costs of care in the ED ($680; 1.060 to 270: all CI 95). The present meta-analysis shows that a strategy with CCTA used as first imaging test for low- and intermediate-risk patients presenting to the ED with chest pain appears safe and seems not to increase subsequent invasive coronary angiographies. The approach is cost-effective although limited data and incomplete cost analyses have been performed. CCTA increases coronary revascularizations, with still an unknown effect on prognosis, especially in the long term.
2013
coronary computed tomographic angiography; low-risk chest pain; ed
01 Pubblicazione su rivista::01a Articolo in rivista
Coronary computed tomographic angiography for detection of coronary artery disease in patients presenting to the emergency department with chest pain: a meta-analysis of randomized clinical trials / F., D'Ascenzo; E., Cerrato; BIONDI ZOCCAI, Giuseppe; P., Omede; F., Sciuto; D. g., Presutti; G., Quadri; G. l., Raff; J. a., Goldstein; H., Litt; Frati, Giacomo; M. j., Reed; C., Moretti; F., Gaita. - In: EUROPEAN HEART JOURNAL. CARDIOVASCULAR IMAGING. - ISSN 2047-2404. - STAMPA. - 14:8(2013), pp. 782-789. [10.1093/ehjci/jes287]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/505958
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