Comparative Effectiveness of Coronary CT Angiography and Standard of Care for Evaluating Acute Chest Pain: A Living Systematic Review and Meta-Analysis.

Purpose: To perform a living systematic review and meta-analysis of randomized controlled trials comparing the effectiveness of coronary CT angiography (CCTA) and standard of care (SOC) in the evaluation of acute chest pain (ACP).
Materials and Methods: Multiple electronic databases were systematically searched, with the most recent search conducted on October 31, 2022. Studies were stratified into two groups according to the pretest probability for acute coronary syndrome (group 1 with predominantly low-to-intermediate risk vs group 2 with high risk). A meta-regression analysis was also conducted using participant risk, type of SOC used, and the use or nonuse of high-sensitivity troponins as independent variables.
Results: The final analysis included 22 randomized controlled trials (9379 total participants; 4956 assigned to CCTA arms and 4423 to SOC arms). There was a 14% reduction in the length of stay and a 17% reduction in immediate costs for the CCTA arm compared with the SOC arm. In group 1, the length of stay was 17% shorter and costs were 21% lower using CCTA. There was no evidence of differences in referrals to invasive coronary angiography, myocardial infarction, mortality, rate of hospitalization, further stress testing, or readmissions between CCTA and SOC arms. There were more revascularizations (relative risk, 1.45) and medication changes (relative risk, 1.33) in participants with low-to-intermediate acute coronary syndrome risk and increased radiation exposure in high-risk participants (mean difference, 7.24 mSv) in the CCTA arm compared with the SOC arm. The meta-regression analysis found significant differences between CCTA and SOC arms for rate of hospitalization, further stress testing, and medication changes depending on the type of SOC ( P < .05).
Conclusion: The results support the use of CCTA as a safe, rapid, and less expensive in the short term strategy to exclude acute coronary syndrome in low- to intermediate-risk patients presenting with acute chest pain. Keywords: Acute Coronary Syndrome, Chest Pain, Emergency Department, Coronary Computed Tomography, Usual Care Supplemental material is available for this article. Published under a CC BY 4.0 license.
Competing Interests: Disclosures of conflicts of interest: M.F.B. No relevant relationships. A.C. Royalties from Elsevier. Y.X. Associate editor and statistician for Radiology: Cardiothoracic Imaging. H.L. Support from Siemens Healthineers and Philips Healthcare to institution; travel support from Siemens Healthineers to institution; deputy editor of Radiology: Cardiothoracic Imaging. D.B.D. Institutional research contracts from Abbott, Siemens Healthineers, Roche, Quidel, and Ortho Clinical Diagnostics; participation on NIH PETAL Network data and safety monitoring board; member of the Academy of Academic Chairs of Emergency Medicine Executive Committee and Emergencies in Medicine Board of Directors. S.A. Royalties from Elsevier; editor of Radiology: Cardiothoraocic Imaging. F.U.K. Grants from the Radiological Society of North America and Edwards Lifesciences; consulting fees from Bayer; honoraria for lecture from the International Society for Cell and Gene Therapy; travel support from UT Southwestern Medical Center; associate editor of Radiology: Cardiothoracic Imaging.
(© 2023 by the Radiological Society of North America, Inc.)