A meta-analysis and systematic review of computed tomography angiography as a diagnostic triage tool for patients with chest pain presenting to the emergency department
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To assess clinical utility of computed tomography angiography (CTA) in the diagnosis of chest pain patients presenting to emergency departments (EDs), we conducted a meta-analysis of CTA in patients with suspected acute coronary syndromes (ACSs).
386 studies were identified on initial review of literature. Inclusion criteria were: (1) prospective study with ≥1 month follow-up, (2) use of CTA in the ED setting, (3) use of ACC/AHA definitions for ACS and robust assessment of major adverse cardiac events, (4) ≥30 patients, and (5) study population with initial non-diagnostic ECGs and negative biomarkers.
Nine studies (N = 1349) formed the data set. The pooled patient population was 52 ± 2 years of age, 51% male, with low to intermediate pretest probability for ACS. Risk factors included 12% diabetes, 42% hypertension, 35% smokers, 29% had hyperlipidemia, and 7% known CAD. ACS was subsequently diagnosed in 10% of patients. The bivariate summary estimate of sensitivity of CTA for ACS diagnosis was 95% (95% CI 88-100) and specificity was 87% (95% CI 83-92), yielding a negative likelihood ratio of 0.06 (95% CI 0-0.14) and positive likelihood ratio of 7.4 (95% CI 4.8-10). The 30-day event rate included no deaths and no additional MIs.
Coronary CTA demonstrates a high sensitivity and a low negative likelihood ratio of 0.06, and is effective in ruling out the presence of ACS in low to intermediate risk patients presenting to the ED with acute chest pain.
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- A meta-analysis and systematic review of computed tomography angiography as a diagnostic triage tool for patients with chest pain presenting to the emergency department
Journal of Nuclear Cardiology
Volume 19, Issue 2 , pp 364-376
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Computed tomography (CT)
- acute coronary syndromes
- diagnostic and prognostic application
- emergency department
- chest pain
- Industry Sectors
- Author Affiliations
- 1. Division of Cardiovascular Medicine, Duke University Medical Center (DUMC), P.O. Box 31328, Durham, NC, 27710, USA
- 2. Department of Internal Medicine, Duke University Medical Center (DUMC), Durham, NC, USA
- 3. Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA
- 6. The Aga Khan University, Karachi, Pakistan
- 4. Cardiovascular Imaging Center, Duke Clinical Research Institute, Durham, NC, USA
- 5. Durham VA Medical Center, Durham, NC, USA