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.
Fabrizio D'Ascenzo,Enrico Cerrato,Giuseppe Biondi-Zoccai,Pierluigi Omedè,Filippo Sciuto,Davide Giacomo Presutti,Giorgio Quadri,Gilbert L. Raff,James A. Goldstein,Harold Litt,Giacomo Frati,Matthew J. Reed,Claudio Moretti,Fiorenzo Gaita +13 more
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TLDR
A 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.Abstract:
Background 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.
Methods 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)].
Results 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 (1.21–2.92). 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%).
Conclusion 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.read more
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2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
Martha Gulati,Phillip D. Levy,Debabrata Mukherjee,Ezra A. Amsterdam,Deepak L. Bhatt,Kim K. Birtcher,Ron Blankstein,Jack H. Boyd,Renee P. Bullock-Palmer,Theresa Conejo,Deborah B. Diercks,Federico Gentile,John P Greenwood,Erik P. Hess,Steven M. Hollenberg,Wael A Jaber,Hani Jneid,Jose A. Joglar,David A. Morrow,Robert E. O'Connor,Michael A. Ross,Leslee J. Shaw +21 more
TL;DR: The 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain this paper provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain.
High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography
TL;DR: Noninvasive 64-slice CT coronary angiography accurately detects coronary stenoses in patients in sinus rhythm and presenting with atypical chest pain, stable or unstable angina, or non-ST-segment elevation myocardial infarction.
Journal ArticleDOI
2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain
Martha Gulati,Phillip D. Levy,Debabrata Mukherjee,Ezra A. Amsterdam,Deepak L. Bhatt,Kim K. Birtcher,Ron Blankstein,Jack H. Boyd,Renee P. Bullock-Palmer,Theresa Conejo,Deborah B. Diercks,Federico Gentile,John P Greenwood,Erik P. Hess,Steven M. Hollenberg,Wael A. Jaber,Hani Jneid,Jose A. Joglar,David A. Morrow,Robert E. O'Connor,Michael A. Ross,Leslee J. Shaw +21 more
Journal ArticleDOI
SCCT guidelines on the use of coronary computed tomographic angiography for patients presenting with acute chest pain to the emergency department: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee.
Gilbert L. Raff,Kavitha Chinnaiyan,Ricardo C. Cury,Mario T. Garcia,Harvey S. Hecht,Judd E. Hollander,Brian J. O'Neil,Allen J. Taylor,Udo Hoffmann +8 more
TL;DR: This research presents a novel and scalable approach to cardiology called “SmartCardiology,” which aims to provide real-time information about the activity of the autonomic nervous system and its role in heart attack and stroke.
Journal ArticleDOI
Coronary Computed Tomography Angiography vs Functional Stress Testing for Patients With Suspected Coronary Artery Disease: A Systematic Review and Meta-analysis.
TL;DR: Compared with functional stress testing, CCTA is associated with a reduced incidence of myocardial infarction but an increased incidence of invasive coronary angiography, revascularization, CAD diagnoses, and new prescriptions for aspirin and statins.
References
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Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement.
TL;DR: The QUOROM Statement (QUality Of Reporting Of Meta-analyses) as mentioned in this paper was developed to address the suboptimal reporting of systematic reviews and meta-analysis of randomized controlled trials.
Journal ArticleDOI
Assessing the quality of reports of randomized clinical trials : is blinding necessary?
Alejandro R. Jadad,R. A. Moore,Dawn Carroll,C. Jenkinson,David Reynolds,David J. Gavaghan,Henry J McQuay +6 more
TL;DR: An instrument to assess the quality of reports of randomized clinical trials (RCTs) in pain research is described and its use to determine the effect of rater blinding on the assessments of quality is described.
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The Revised CONSORT Statement for Reporting Randomized Trials: Explanation and Elaboration
Douglas G. Altman,Kenneth F. Schulz,David Moher,Matthias Egger,Frank Davidoff,Diana Elbourne,Peter C Gøtzsche,Tom Lang +7 more
TL;DR: The Consort Statement as mentioned in this paper is a group of scientists and editors developed to improve the quality of reporting of randomized, controlled trials (RCTs) by providing guidance to authors about how to improve their reporting of their trials.
Journal ArticleDOI
Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial.
Matthew J. Budoff,David A. Dowe,James G. Jollis,Michael J. Gitter,John Sutherland,Edward Halamert,Markus Scherer,Raye L. Bellinger,Arthur Martin,Robert Benton,Augustin Delago,James K. Min +11 more
TL;DR: In this prospective multicenter trial of chest pain patients without known CAD, 64-multidetector row CCTA possesses high diagnostic accuracy for detection of obstructive coronary stenosis at both thresholds of 50% and 70% stenosis.
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