Clinical Outcomes After Evaluation of Stable Chest Pain by Coronary Computed Tomographic Angiography Versus Usual Care: A Meta-Analysis

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorBITTENCOURT, Marcio Sommer
dc.contributor.authorHULTEN, Edward A.
dc.contributor.authorMURTHY, Venkatesh L.
dc.contributor.authorCHEEZUM, Michael
dc.contributor.authorROCHITTE, Carlos E.
dc.contributor.authorCARLI, Marcelo F. Di
dc.contributor.authorBLANKSTEIN, Ron
dc.date.accessioned2016-07-18T13:08:52Z
dc.date.available2016-07-18T13:08:52Z
dc.date.issued2016
dc.description.abstractBackground Limited data exist on how noninvasive testing options compare for evaluating patients with suspected stable coronary artery disease. In this study, we have performed a meta-analysis of randomized controlled trials comparing the use of coronary computed tomographic angiography (CTA) with usual care. Methods and Results We systematically searched databases for randomized clinical trials comparing coronary CTA with usual care for the evaluation of stable chest pain with follow-up for cardiovascular outcomes. The primary outcomes were myocardial infarction and all-cause mortality. We identified 4 randomized clinical trials, including a total of 7403 patients undergoing coronary CTA and 7414 patients undergoing usual care with various functional testing approaches. When compared with usual care, the use of coronary CTA was associated with a significant reduction in the annual rate of myocardial infarction (rate ratio, 0.69; 95% confidence interval, 0.49-0.98; P=0.038), but no difference was found in all-cause mortality. There was a trend toward more invasive coronary angiographies 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). Significant heterogeneity for invasive coronary angiography and revascularization was noted, which was attributable to the Scottish Computed Tomography of the HEART (SCOT-HEART) study. We found no difference in the rate of admission for cardiac chest pain (rate ratio, 1.21; 95% confidence interval, 0.95-1.54). Conclusions In comparison to usual care, an initial investigation of suspected stable coronary artery disease using coronary CTA resulted in a significant reduction in myocardial infarction, an increased incidence of coronary revascularization, and no effect in all-cause mortality. Future studies should further define whether the potential reduction in myocardial infarction identified justifies the increased resource utilization associated with coronary CTA.
dc.description.indexMEDLINE
dc.identifier.citationCIRCULATION-CARDIOVASCULAR IMAGING, v.9, n.4, article ID e004419, 9p, 2016
dc.identifier.doi10.1161/CIRCIMAGING.115.004419
dc.identifier.eissn1942-0080
dc.identifier.issn1941-9651
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/14594
dc.language.isoeng
dc.publisherLIPPINCOTT WILLIAMS & WILKINS
dc.relation.ispartofCirculation-Cardiovascular Imaging
dc.rightsrestrictedAccess
dc.rights.holderCopyright LIPPINCOTT WILLIAMS & WILKINS
dc.subjectangina
dc.subjectstable
dc.subjectchest pain
dc.subjectcoronary angiography
dc.subjectcoronary artery disease
dc.subjectmyocardial infarction
dc.subject.otherinternational multicenter registry
dc.subject.otherfractional flow reserve
dc.subject.otherartery-disease
dc.subject.otherct angiography
dc.subject.othermyocardial-perfusion
dc.subject.otherprognostic value
dc.subject.otherdiagnostic performance
dc.subject.othermedical therapy
dc.subject.otherappropriate use
dc.subject.otherrisk-assessment
dc.subject.wosCardiac & Cardiovascular Systems
dc.subject.wosRadiology, Nuclear Medicine & Medical Imaging
dc.titleClinical Outcomes After Evaluation of Stable Chest Pain by Coronary Computed Tomographic Angiography Versus Usual Care: A Meta-Analysis
dc.typearticle
dc.type.categoryoriginal article
dc.type.versionpublishedVersion
dspace.entity.typePublication
hcfmusp.affiliation.countryEstados Unidos
hcfmusp.affiliation.countryisous
hcfmusp.author.externalHULTEN, Edward A.:Walter Reed Natl Mil Med Ctr, Dept Med, Serv Cardiol, Bethesda, MD USA
hcfmusp.author.externalMURTHY, Venkatesh L.:Univ Michigan, Dept Med, Div Cardiovasc Med, Ann Arbor, MI 48109 USA
hcfmusp.author.externalCHEEZUM, Michael:Brigham & Womens Hosp, Dept Med, Div Cardiovasc, Noninvas Cardiovasc Imaging Program, Boston, MA 02115 USA; Brigham & Womens Hosp, Dept Radiol, Noninvas Cardiovasc Imaging Program, Boston, MA 02115 USA; Harvard Univ, Sch Med, Boston, MA 02115 USA
hcfmusp.author.externalCARLI, Marcelo F. Di:Brigham & Womens Hosp, Dept Med, Div Cardiovasc, Noninvas Cardiovasc Imaging Program, Boston, MA 02115 USA; Brigham & Womens Hosp, Dept Radiol, Noninvas Cardiovasc Imaging Program, Boston, MA 02115 USA; Harvard Univ, Sch Med, Boston, MA 02115 USA
hcfmusp.author.externalBLANKSTEIN, Ron:Brigham & Womens Hosp, Dept Med, Div Cardiovasc, Noninvas Cardiovasc Imaging Program, Boston, MA 02115 USA; Brigham & Womens Hosp, Dept Radiol, Noninvas Cardiovasc Imaging Program, Boston, MA 02115 USA; Harvard Univ, Sch Med, Boston, MA 02115 USA
hcfmusp.citation.scopus120
hcfmusp.contributor.author-fmusphcMARCIO SOMMER BITTENCOURT
hcfmusp.contributor.author-fmusphcCARLOS EDUARDO ROCHITTE
hcfmusp.description.articlenumbere004419
hcfmusp.description.issue4
hcfmusp.description.volume9
hcfmusp.origemWOS
hcfmusp.origem.pubmed27072303
hcfmusp.origem.scopus2-s2.0-84968810530
hcfmusp.origem.wosWOS:000374795700007
hcfmusp.publisher.cityPHILADELPHIA
hcfmusp.publisher.countryUSA
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