Meta-analysis of coronary computed tomography angiography versus standard of care strategy for the evaluation of low risk chest pain: Are randomized controlled trials and cohort studies showing the same evidence?

Georges El-Hayek, Alexandre Benjo, Seth Uretsky, Mouaz Al-Mallah, Randy Cohen, Daniel Bamira, Patricia Chavez, Francisco Nascimento, Orlando Santana, Rajan Patel, João L. Cavalcante

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background Randomized control trials (RCTs) have established the use of Coronary Computed Tomography Angiography (CCTA) for the evaluation of low to intermediate risk patients presenting with acute chest pain to the emergency department (ED). However, concerns remain regarding the downstream resource utilization and the clinical impact of such strategy.

Methods We performed a meta-analysis of existing studies to compare CCTA to the standard of care (SOC) strategies in the low to intermediate risk chest pain patients. We abstracted the reported incidence of acute coronary syndromes (ACS), the total number of invasive coronary angiography (ICA) and subsequent revascularization procedures, the rates of hospital readmissions and repeat ED visits. We stratified the results according to the type of the studies (randomized or not) and used random effect analysis for the studied outcomes.

Results Four RCTs and 3 case-control studies with 3306 patients undergoing CCTA and 2752 assigned to SOC were included in the analysis. Following the index visit, we observed a significant reduction in the risk of ACS (RR: 0.26, 95% CI, 0.08 to 0.87; p = 0.03) and in the rates of repeat ED visits (RR: 0.58, 95% CI: 0.36 to 0.94; p = 0.03). In addition, a trend toward less hospital readmission (p = 0.07) was noted. There was no difference in ICA (p = 0.99) but an increase in revascularization procedures (RR: 1.46, 95% CI: 1.09 to 1.94; p = 0.01).

Conclusion CCTA use in the ED for the triage of low to intermediate risk patients reduces the risk of future ACS and subsequent ED visits for chest pain.

Original languageEnglish (US)
Pages (from-to)238-245
Number of pages8
JournalInternational Journal of Cardiology
Volume177
Issue number1
DOIs
StatePublished - Nov 15 2014
Externally publishedYes

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Standard of Care
Chest Pain
Meta-Analysis
Hospital Emergency Service
Cohort Studies
Randomized Controlled Trials
Acute Coronary Syndrome
Patient Readmission
Coronary Angiography
Triage
Acute Pain
Risk Reduction Behavior
Case-Control Studies
Computed Tomography Angiography
Incidence

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

El-Hayek, Georges ; Benjo, Alexandre ; Uretsky, Seth ; Al-Mallah, Mouaz ; Cohen, Randy ; Bamira, Daniel ; Chavez, Patricia ; Nascimento, Francisco ; Santana, Orlando ; Patel, Rajan ; Cavalcante, João L. / Meta-analysis of coronary computed tomography angiography versus standard of care strategy for the evaluation of low risk chest pain : Are randomized controlled trials and cohort studies showing the same evidence?. In: International Journal of Cardiology. 2014 ; Vol. 177, No. 1. pp. 238-245.
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title = "Meta-analysis of coronary computed tomography angiography versus standard of care strategy for the evaluation of low risk chest pain: Are randomized controlled trials and cohort studies showing the same evidence?",
abstract = "Background Randomized control trials (RCTs) have established the use of Coronary Computed Tomography Angiography (CCTA) for the evaluation of low to intermediate risk patients presenting with acute chest pain to the emergency department (ED). However, concerns remain regarding the downstream resource utilization and the clinical impact of such strategy.Methods We performed a meta-analysis of existing studies to compare CCTA to the standard of care (SOC) strategies in the low to intermediate risk chest pain patients. We abstracted the reported incidence of acute coronary syndromes (ACS), the total number of invasive coronary angiography (ICA) and subsequent revascularization procedures, the rates of hospital readmissions and repeat ED visits. We stratified the results according to the type of the studies (randomized or not) and used random effect analysis for the studied outcomes.Results Four RCTs and 3 case-control studies with 3306 patients undergoing CCTA and 2752 assigned to SOC were included in the analysis. Following the index visit, we observed a significant reduction in the risk of ACS (RR: 0.26, 95{\%} CI, 0.08 to 0.87; p = 0.03) and in the rates of repeat ED visits (RR: 0.58, 95{\%} CI: 0.36 to 0.94; p = 0.03). In addition, a trend toward less hospital readmission (p = 0.07) was noted. There was no difference in ICA (p = 0.99) but an increase in revascularization procedures (RR: 1.46, 95{\%} CI: 1.09 to 1.94; p = 0.01).Conclusion CCTA use in the ED for the triage of low to intermediate risk patients reduces the risk of future ACS and subsequent ED visits for chest pain.",
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Meta-analysis of coronary computed tomography angiography versus standard of care strategy for the evaluation of low risk chest pain : Are randomized controlled trials and cohort studies showing the same evidence? / El-Hayek, Georges; Benjo, Alexandre; Uretsky, Seth; Al-Mallah, Mouaz; Cohen, Randy; Bamira, Daniel; Chavez, Patricia; Nascimento, Francisco; Santana, Orlando; Patel, Rajan; Cavalcante, João L.

In: International Journal of Cardiology, Vol. 177, No. 1, 15.11.2014, p. 238-245.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Meta-analysis of coronary computed tomography angiography versus standard of care strategy for the evaluation of low risk chest pain

T2 - Are randomized controlled trials and cohort studies showing the same evidence?

AU - El-Hayek, Georges

AU - Benjo, Alexandre

AU - Uretsky, Seth

AU - Al-Mallah, Mouaz

AU - Cohen, Randy

AU - Bamira, Daniel

AU - Chavez, Patricia

AU - Nascimento, Francisco

AU - Santana, Orlando

AU - Patel, Rajan

AU - Cavalcante, João L.

PY - 2014/11/15

Y1 - 2014/11/15

N2 - Background Randomized control trials (RCTs) have established the use of Coronary Computed Tomography Angiography (CCTA) for the evaluation of low to intermediate risk patients presenting with acute chest pain to the emergency department (ED). However, concerns remain regarding the downstream resource utilization and the clinical impact of such strategy.Methods We performed a meta-analysis of existing studies to compare CCTA to the standard of care (SOC) strategies in the low to intermediate risk chest pain patients. We abstracted the reported incidence of acute coronary syndromes (ACS), the total number of invasive coronary angiography (ICA) and subsequent revascularization procedures, the rates of hospital readmissions and repeat ED visits. We stratified the results according to the type of the studies (randomized or not) and used random effect analysis for the studied outcomes.Results Four RCTs and 3 case-control studies with 3306 patients undergoing CCTA and 2752 assigned to SOC were included in the analysis. Following the index visit, we observed a significant reduction in the risk of ACS (RR: 0.26, 95% CI, 0.08 to 0.87; p = 0.03) and in the rates of repeat ED visits (RR: 0.58, 95% CI: 0.36 to 0.94; p = 0.03). In addition, a trend toward less hospital readmission (p = 0.07) was noted. There was no difference in ICA (p = 0.99) but an increase in revascularization procedures (RR: 1.46, 95% CI: 1.09 to 1.94; p = 0.01).Conclusion CCTA use in the ED for the triage of low to intermediate risk patients reduces the risk of future ACS and subsequent ED visits for chest pain.

AB - Background Randomized control trials (RCTs) have established the use of Coronary Computed Tomography Angiography (CCTA) for the evaluation of low to intermediate risk patients presenting with acute chest pain to the emergency department (ED). However, concerns remain regarding the downstream resource utilization and the clinical impact of such strategy.Methods We performed a meta-analysis of existing studies to compare CCTA to the standard of care (SOC) strategies in the low to intermediate risk chest pain patients. We abstracted the reported incidence of acute coronary syndromes (ACS), the total number of invasive coronary angiography (ICA) and subsequent revascularization procedures, the rates of hospital readmissions and repeat ED visits. We stratified the results according to the type of the studies (randomized or not) and used random effect analysis for the studied outcomes.Results Four RCTs and 3 case-control studies with 3306 patients undergoing CCTA and 2752 assigned to SOC were included in the analysis. Following the index visit, we observed a significant reduction in the risk of ACS (RR: 0.26, 95% CI, 0.08 to 0.87; p = 0.03) and in the rates of repeat ED visits (RR: 0.58, 95% CI: 0.36 to 0.94; p = 0.03). In addition, a trend toward less hospital readmission (p = 0.07) was noted. There was no difference in ICA (p = 0.99) but an increase in revascularization procedures (RR: 1.46, 95% CI: 1.09 to 1.94; p = 0.01).Conclusion CCTA use in the ED for the triage of low to intermediate risk patients reduces the risk of future ACS and subsequent ED visits for chest pain.

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