title: Multi-detector computerized tomography angiography for evaluation of acute chest pain--a meta analysis and systematic review of literature.
abstract: BACKGROUND
  Evaluation of pain localized to the chest in the emergency room is, challenging, time-consuming, costly, and often inconclusive. Available research, though limited, suggests a role for MDCTA in the evaluation of patients with acute chest pain of low to intermediate risk, for identifying and excluding ACSs during the initial emergency department evaluation. Accordingly, our aim was to conduct a meta-analysis to assess the diagnostic accuracy of MDCTA in this setting.
  
  
  METHODS
  We included all studies that compared MDCTA with either coronary angiography or standard of care for early and accurate triage of patients presenting with acute chest pain. Published studies were identified by searches of the Pubmed, Ovid and Google scholar databases as well as hand searches of selected references. Data were extracted independently by two reviewers. Included studies were evaluated for heterogeneity. Meta-analysis was performed at patient level using a random-effects model.
  
  
  RESULTS
  16 studies totaling 1119 patients were included in the current meta-analysis: one randomized trial, one retrospective analysis and fourteen prospective cohort studies. Pooled DOR was 190.80 (95%CI, 102.94-353.65). The pooled sensitivity and specificity were 0.96 (95%CI, 0.93-0.98) and 0.92(95%CI, 0.89-0.94) respectively. The pooled NLR and PLR were 0.09 (95%CI, 0.06-0.14) and 10.12 (95%CI, 6.73-15.22).
  
  
  CONCLUSIONS
  MDCTA has an excellent diagnostic accuracy in detection of significant coronary artery stenosis in patients with acute chest pain. This diagnostic accuracy of MDCTA has a potential for rapid triage of patients in the ED, with acute chest pain of low to intermediate risk of acute coronary syndrome, to rule out significant epicardial stenosis as the etiology of chest pain.
authors.affiliation: Caritas St Elizabeth Medical Center/Tufts School of Medicine, 736 Cambridge street, Brighton, MA 02135, USA. ganeshathappan@gmail.com
authors.forename: Ganesh
authors.initials: G
authors.lastname: Athappan
authors.forename: Muzzmal
authors.initials: M
authors.lastname: Habib
authors.forename: Thirumalaikolundusubramanian
authors.initials: T
authors.lastname: Ponniah
authors.forename: Lakshmanan
authors.initials: L
authors.lastname: Jeyaseelan
mesh_terms: D000208:Acute Disease; D002637:Chest Pain / Q000209:etiology*; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000175:diagnosis; D006801:Humans; D016013:Likelihood Functions; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed