Coronary computed tomography angiography in patients with chronic chest pain: systematic review of evidence base and cost-effectiveness.
The diagnostic evaluation of patients without known coronary artery disease presenting with chronic stable chest pain or angina equivalent is complex. Imaging often plays a role in diagnosis and risk stratification, and a variety of techniques are available, each with inherent and situation-specific advantages and disadvantages. Coronary computed tomography angiography (CTA) has been proposed as a fast, noninvasive, reliable test to rule out disease in this population, with potential improvements in costs and outcomes compared with alternative strategies. The relatively rapid rise in coronary CTA utilization, however, has led to strong calls from clinicians and health care policy organizations alike to provide high-level evidence supporting its use. The present article provides a review of the available evidence. Alternative diagnostic strategies and currently accepted indications for coronary CTA are discussed, followed by evaluation of the evidence on diagnostic accuracy, prognostic value, effect on outcomes and health care utilization, and safety. We end with a brief outlook on future developments.
Heart and Vascular Center, Medical University of South Carolina, Charleston, SC, USA. jnance5@jhmi.edu
John William
JW
Nance
Fabian
F
Bamberg
U Joseph
UJ
Schoepf
D002637:Chest Pain / Q000000981:diagnostic imaging* / Q000209:etiology; D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D019317:Evidence-Based Medicine; D006291:Health Policy; D006801:Humans; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data