title: Coronary computed tomographic angiography for detection of coronary artery disease in patients presenting to the emergency department with chest pain: a meta-analysis of randomized clinical trials.
abstract: BACKGROUND
  Assessment of chest pain patients remains a clinical challenge in the emergency department (ED). Several randomized controlled trials (RCTs) have shown the additive value of coronary computed tomographic angiography (CCTA) compared with standard care. Not all of them, however, had enough power to detect differences in clinical outcomes like revascularization. Therefore, we performed a meta-analysis to test the safety and efficacy of this non-invasive diagnostic approach in low- and intermediate-risk chest pain patients.
  
  
  METHODS
  MEDLINE/PubMed was systematically screened for RCTs comparing CCTA and non-CCTA approaches for ED patients presenting with chest pain. Baseline features, diagnostic strategies, and outcome data were appraised and pooled with random-effect methods computing summary estimates [95% confidence intervals (CIs)].
  
  
  RESULTS
  A total of four RCT studies including 2567 patients were identified, with similar inclusion and exclusion criteria. Patients in the CCTA group were more likely to undergo percutaneous or surgical revascularization during their index visit, with an odd ratio of 1.88 (1.21-2.92). Time to diagnosis was reduced with CCTA (-7.68 h;-12.70 to 2.66) along with costs of care in the ED (-$680; -1.060 to -270: all CI 95%).
  
  
  CONCLUSIONS
  The present meta-analysis shows that a strategy with CCTA used as first imaging test for low- and intermediate-risk patients presenting to the ED with chest pain appears safe and seems not to increase subsequent invasive coronary angiographies. The approach is cost-effective although limited data and incomplete cost analyses have been performed. CCTA increases coronary revascularizations, with still an unknown effect on prognosis, especially in the long term.
authors.affiliation: Division of Cardiology, University of Turin, Torin, Italy. fabrizio.dascenzo@gmail.com
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.forename: Enrico
authors.initials: E
authors.lastname: Cerrato
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Omedè
authors.forename: Filippo
authors.initials: F
authors.lastname: Sciuto
authors.forename: Davide Giacomo
authors.initials: DG
authors.lastname: Presutti
authors.forename: Giorgio
authors.initials: G
authors.lastname: Quadri
authors.forename: Gilbert L
authors.initials: GL
authors.lastname: Raff
authors.forename: James A
authors.initials: JA
authors.lastname: Goldstein
authors.forename: Harold
authors.initials: H
authors.lastname: Litt
authors.forename: Giacomo
authors.initials: G
authors.lastname: Frati
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Reed
authors.forename: Claudio
authors.initials: C
authors.lastname: Moretti
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
mesh_terms: D002637:Chest Pain / Q000000981:diagnostic imaging*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D014057:Tomography, X-Ray Computed