title: Comparative safety and effectiveness of coronary computed tomography: Systematic review and meta-analysis including 11 randomized controlled trials and 19,957 patients.
abstract: OBJECTIVE
  The clinical approach to suspected or established coronary artery disease (CAD) has been revolutionized in the last few decades by coronary computed tomography (coroCT). Yet, uncertainty persists on its comparative diagnostic and clinical effectiveness. We conducted a systematic review on randomized controlled trials (RCTs) of coroCT.
  
  
  METHODS
  We searched RCTs in PubMed and The Cochrane Library, extracting as outcomes of interest long-term rates of death, myocardial infarction, revascularization, and invasive coronary angiography. Effects were estimated with risk ratios (RR) and 95% confidence intervals.
  
  
  RESULTS
  A total of 11 trials were included, with 19,957 patients followed for a median of 6months. One trial focused on screening, 3 on stable CAD, and 7 on acute CAD. Meta-analysis showed that coroCT was associated with a trend toward fewer deaths or myocardial infarctions (RR=0.84 [0.70-1.01]) whereas no significant difference was found for the risk of death (RR=0.91 [0.71-1.18]). Conversely, the risk of myocardial infarction tended to be lower with coroCT at the overall analysis (RR=0.77 [0.59-1.02]), and this effect reached statistical significance in studies focusing on subjects with stable CAD (RR=0.69 [0.49-0.99]). These potential benefits were offset (or mediated) by a significant albeit modest increase in the need for invasive angiography (RR=1.36 [1.08-1.72]), and ensuing coronary revascularization (RR=1.76 [1.29-2.40]).
  
  
  CONCLUSIONS
  According to the current evidence base, coroCT is associated with an increased usage of invasive angiography and coronary revascularization when compared to standard of care, with possible benefits on nonfatal myocardial infarction, but without significant benefits on death or the composite of death or myocardial infarction.
authors: Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Rome, Italy; Ostia Radiologica, Rome, Italy; ETISAN, Rome, Italy.
authors: Francesco
authors: F
authors: Nudi
authors: Division of Cardiology, Catholic University, Rome, Italy.
authors: Marzia
authors: M
authors: Lotrionte
authors: Division of Cardiology, Catholic University, Rome, Italy.
authors: Luigi M
authors: LM
authors: Biasucci
authors: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.
authors: Mariangela
authors: M
authors: Peruzzi
authors: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.
authors: Antonino G M
authors: AGM
authors: Marullo
authors: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy.
authors: Giacomo
authors: G
authors: Frati
authors: Division of Radiology, University of Rome, Rome, Italy.
authors: Valentina
authors: V
authors: Valenti
authors: Unità Operativa di Interventistica Cardiovascolare, Presidio Ospedaliero Pineta Grande, Castel Volturno, Italy; Unità Operativa di Emodinamica, Casa di Salute Santa Lucia, San Giuseppe Vesuviano, Italy.
authors: Arturo
authors: A
authors: Giordano
authors: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy. Electronic address: giuseppe.biondizoccai@uniroma1.it.
authors: Giuseppe
authors: G
authors: Biondi-Zoccai
mesh_terms: D017023:Coronary Angiography / Q000009:adverse effects / Q000592:standards*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality; D006801:Humans; D009026:Mortality / Q000639:trends; D016032:Randomized Controlled Trials as Topic / Q000379:methods / Q000592:standards*; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000592:standards*; D016896:Treatment Outcome
keywords: Computed tomography; Coronary artery disease; Meta-analysis; Systematic review