Suspected Coronary Artery Disease: Coronary CT Angiography vs Standard Care
CCTA increased the need for invasive coronary angiography.
In a trial sequential analysis, researchers from Penn State Milton S. Hershey Medical Center in Hershey, Pennsylvania, compared coronary computed tomographic angiography (CCTA) with standard care in patients with suspected coronary artery disease (CAD).
The data was presented at the 66th Annual Scientific Session & Expo of the American College of Cardiology in Washington, DC.
A total of 12 published randomized controlled trials were included in this analysis, most of which included functional testing for the assessment of patients with suspected CAD.
The end points of death plus myocardial infarction (MI), MI alone, cardiac hospitalization, invasive coronary angiography (ICA), and revascularization were not significantly reduced with CCTA. Death plus MI had an odds ratio (OR) of 0.87 (95% CI, 0.68-1.10), MI alone had an OR of 0.75 (95% CI, 0.51-1.09), and cardiac hospitalization had an OR of 0.94 (95% CI, 0.68-1.29).
Trial sequential analysis was performed with an alpha error of 5%, and excluded a 25% relative risk reduction in death plus MI and cardiac hospitalization, as well as a 40% relative risk reduction in MI alone compared with standard care. In addition, CCTA significantly increased the need for ICA (OR, 1.5; 95% CI, 1.31-1.72) and revascularization (OR, 2.06; 95% CI, 1.76-2.41).
Because of the increased need for ICA without a reduction in cardiac events, the researchers concluded that CAD is best diagnosed using clinical and functional assessment.
Foy AJ, Dhruva SS, Peterson B, Morgan D, Mandrola J, Redberg R. Effectiveness of coronary CT angiography vs standard care for the assessment of patients with suspected coronary artery disease: a trial sequential analysis. Abstract 1126-328. Presented at: the 66th Annual Scientific Session & Expo of the American College of Cardiology. March 17-19, 2017; Washington, DC.