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

Imagem de Miniatura
Arquivos
art_BITTENCOURT_Clinical_Outcomes_After_Evaluation_of_Stable_Chest_Pain_2016.PDF (1.57 MB)
Citações na Scopus
120
Tipo de produção
article
Data de publicação
2016
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
LIPPINCOTT WILLIAMS & WILKINS
Autores
HULTEN, Edward A.
MURTHY, Venkatesh L.
CHEEZUM, Michael
CARLI, Marcelo F. Di
BLANKSTEIN, Ron
Citação
CIRCULATION-CARDIOVASCULAR IMAGING, v.9, n.4, article ID e004419, 9p, 2016
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Background 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.
Palavras-chave
angina, stable, chest pain, coronary angiography, coronary artery disease, myocardial infarction
URI
https://observatorio.fm.usp.br/handle/OPI/14594
Referências
  1. Peters JL, 2006, JAMA-J AM MED ASSOC, V295, P676, DOI 10.1001/jama.295.6.676
  2. Rozanski A, 2013, J AM COLL CARDIOL, V61, P1054, DOI 10.1016/j.jacc.2012.11.056
  3. Cheezum MK, 2013, JACC-CARDIOVASC IMAG, V6, P574, DOI 10.1016/j.jcmg.2012.11.016
  4. Hachamovitch R, 2012, J AM COLL CARDIOL, V59, P462, DOI 10.1016/j.jacc.2011.09.066
  5. Patel MR, 2010, NEW ENGL J MED, V362, P886, DOI 10.1056/NEJMoa0907272
  6. Chow BJW, 2015, ARTERIOSCL THROM VAS, V35, P981, DOI 10.1161/ATVBAHA.114.304351
  7. Hulten E, 2014, CIRC-CARDIOVASC IMAG, V7, P629, DOI 10.1161/CIRCIMAGING.113.001564
  8. Christman MP, 2014, J AM COLL CARDIOL, V63, P1264, DOI 10.1016/j.jacc.2013.11.052
  9. Min JK, 2012, EUR HEART J, V33, P3088, DOI 10.1093/eurheartj/ehs315
  10. Jadad AR, 1996, CONTROL CLIN TRIALS, V17, P1, DOI 10.1016/0197-2456(95)00134-4
  11. McKavanagh P, 2015, EUR HEART J-CARD IMG, V16, P441, DOI 10.1093/ehjci/jeu284
  12. Leipsic J, 2014, AM J ROENTGENOL, V202, P989, DOI 10.2214/AJR.13.11441
  13. Miller JM, 2008, NEW ENGL J MED, V359, P2324, DOI 10.1056/NEJMoa0806576
  14. Cheezum MK, 2015, EUR HEART J-CARD IMG, V16, P1338, DOI 10.1093/ehjci/jev087
  15. Doukky R, 2013, CIRCULATION, V128, P1634, DOI 10.1161/CIRCULATIONAHA.113.002744
  16. Blankstein R, 2010, NAT REV CARDIOL, V7, P226, DOI 10.1038/nrcardio.2010.15
  17. Woodward M, 2007, HEART, V93, P172, DOI 10.1136/hrt.2006.108167
  18. Hulten EA, 2012, J NUCL CARDIOL, V19, P588, DOI 10.1007/s12350-012-9546-5
  19. Stergiopoulos K, 2014, JAMA INTERN MED, V174, P232, DOI 10.1001/jamainternmed.2013.12855
  20. Hoffmann U, 2012, NEW ENGL J MED, V367, P299, DOI 10.1056/NEJMoa1201161
  21. Hulten E, 2013, J AM COLL CARDIOL, V61, P880, DOI 10.1016/j.jacc.2012.11.061
  22. Hulten EA, 2011, J AM COLL CARDIOL, V57, P1237, DOI 10.1016/j.jacc.2010.10.011
  23. Blankstein R, 2009, J AM COLL CARDIOL, V54, P1072, DOI 10.1016/j.jacc.2009.06.014
  24. Yerramasu A, 2011, EUR HEART J SUPPL, V13, pA45
  25. Douglas PS, 2015, NEW ENGL J MED, V372, P1291, DOI 10.1056/NEJMoa1415516
  26. Tonino PAL, 2010, J AM COLL CARDIOL, V55, P2816, DOI 10.1016/j.jacc.2009.11.096
  27. Liberati A, 2009, ANN INTERN MED, V151, pW65
  28. Min JK, 2012, J CARDIOVASC COMPUT, V6, P274, DOI 10.1016/j.jcct.2012.06.002
  29. Bittencourt MS, 2014, CIRC-CARDIOVASC IMAG, V7, P282, DOI 10.1161/CIRCIMAGING.113.001047
  30. Douglas PS, 2015, EUR HEART J, V36, P3359, DOI 10.1093/eurheartj/ehv444
  31. Higgins JPT, 2011, BMJ-BRIT MED J, V343, DOI 10.1136/bmj.d5928
  32. Newby D, 2015, LANCET, V385, P2383, DOI 10.1016/S0140-6736(15)60291-4
  33. Villines TC, 2013, CIRCULATION, V128
  34. Wolk MJ, 2014, J AM COLL CARDIOL, V63, P380, DOI 10.1016/j.jacc.2013.11.009

Coleções
Artigos e Materiais de Revistas Científicas - HU
Artigos e Materiais de Revistas Científicas - HC/ICESP
Artigos e Materiais de Revistas Científicas - HC/InCor
Artigos e Materiais de Revistas Científicas - ODS/03