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Comparison of CT Angiography to Other Noninvasive Testing in Suspected Stable CAD
Study Questions:
In patients with stable chest pain with suspected stable coronary artery disease (CAD), how does coronary computed tomographic angiography (CTA) compare to other noninvasive testing options in terms of the incidence of clinical outcomes?
Methods:
This was a meta-analysis in which randomized clinical trials of coronary CTA for stable chest pain with at least 1 month follow-up post-randomization were included. Nonfatal myocardial infarction (MI) and all-cause death were the primary outcomes. Revascularization by percutaneous coronary intervention or coronary artery bypass grafting and recurrent angina or cardiac chest pain admissions were secondary outcomes.
Results:
The authors identified four randomized clinical trials, including a total of 7,403 patients undergoing coronary CTA and 7,414 patients undergoing usual care with various approaches for functional testing. There were significant differences in the type of testing used as part of usual care across all studies. The relative risk of nonfatal MI was significantly lower in the coronary CTA group, compared to the usual group (relative risk [RR], 0.69; 95% confidence interval [CI], 0.49-0.98; p = 0.038). The incidence of all-cause mortality was not significantly different between the groups. There was a trend toward more invasive coronary angiography among patients undergoing coronary CTA (odds ratio, 1.33; 95% confidence interval, 0.95-1.84; p = 0.09) and higher use of coronary revascularizations (odds ratio, 1.77; 95% confidence interval, 1.14-2.75).
Conclusions:
Compared to other noninvasive testing options in this meta-analysis of four randomized clinical trials comparing usual care to coronary CTA in patients with stable CAD, coronary CTA was associated with a significant reduction in MI, increased incidence of coronary revascularization, and no effect on all-cause mortality.
Perspective:
This is a valuable study that adds to the otherwise limited data available on how noninvasive testing options compare for evaluating patients with suspected stable CAD. Although the use of coronary CTA was associated with a reduction in the incidence of MI (and a significant increase in downstream coronary revascularization), it was not associated with a difference in the rate of all-cause mortality. As the authors opine, ‘Future studies should...define whether the potential reduction in MI identified by this study justifies the increased resource utilization associated with coronary CTA.’
Keywords: Acute Coronary Syndrome, Angina, Stable, Chest Pain, Coronary Angiography, Coronary Artery Bypass, Coronary Artery Disease, Diagnostic Imaging, Myocardial Infarction, Myocardial Ischemia, Myocardial Revascularization, Percutaneous Coronary Intervention, Risk, Secondary Prevention
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