title: Non-invasive assessment of low risk acute chest pain in the emergency department: A comparative meta-analysis of prospective studies.
abstract: BACKGROUND
  The aim of this meta-analysis was to compare the diagnostic accuracy of cardiac computed tomographic angiography (CCTA), stress echocardiography (SE) and radionuclide single photon emission computed tomography (SPECT) for the assessment of chest pain in emergency department (ED) setting.
  
  
  METHODS
  A systematic review of Medline, Cochrane and Embase was undertaken for prospective clinical studies assessing the diagnostic efficacy of CCTA, SE or SPECT, as compared to intracoronary angiography (ICA) or the later presence of major adverse clinical outcomes (MACE), in patients presenting to the ED with chest pain. Standard approach and bivariate analysis were performed.
  
  
  RESULTS
  Thirty-seven studies (15 CCTA, 9 SE, 13 SPECT) comprising a total of 7800 patients fulfilled inclusion criteria. The respective weighted mean sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and total diagnostic accuracy for CCTA were: 95%, 99%, 84%, 100% and 99%, for SE were: 84%, 94%, 73%, 96% and 96%, and for SPECT were: 85%, 86%, 57%, 95% and 88%. There was no significant difference between modalities in terms of NPV. Bivariate analysis revealed that CCTA had statistically greater sensitivity, specificity, PPV and overall diagnostic accuracy when compared to SE and SPECT.
  
  
  CONCLUSIONS
  All three modalities, when employed by an experienced clinician, are highly accurate. Each has its own strengths and limitations making each well suited for different patient groups. CCTA has higher accuracy than SE and SPECT, but it has many drawbacks, most importantly its lack of physiologic data.
authors: Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors: Jorge
authors: J
authors: Romero
authors: Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors: S Arman
authors: SA
authors: Husain
authors: Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors: Anthony A
authors: AA
authors: Holmes
authors: Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors: Iosif
authors: I
authors: Kelesidis
authors: St Luke's Roosevelt Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors: Patricia
authors: P
authors: Chavez
authors: Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors: M Khalid
authors: MK
authors: Mojadidi
authors: Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors: Jeffrey M
authors: JM
authors: Levsky
authors: University of Utah Health Sciences Center & VAMC, Salt Lake City, UT, USA.
authors: Omar
authors: O
authors: Wever-Pinzon
authors: Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors: Cynthia
authors: C
authors: Taub
authors: St Luke's Roosevelt Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors: Harikrishna
authors: H
authors: Makani
authors: Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors: Mark I
authors: MI
authors: Travin
authors: Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors: Ileana L
authors: IL
authors: Piña
authors: Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA. Electronic address: mariogar@montefiore.org.
authors: Mario J
authors: MJ
authors: Garcia
mesh_terms: D000368:Aged; D002637:Chest Pain / Q000000981:diagnostic imaging*; D017023:Coronary Angiography / Q000379:methods; D025401:Echocardiography, Stress; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D011446:Prospective Studies; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: Coronary computed tomographic angiography; Meta-analysis; Non-invasive chest pain assessment; Single-photon emission computed tomography; Stress echocardiography