Hwang IC, et al. - Researchers presumed that coronary computed tomography angiography (CCTA) as initial diagnostic strategy versus usual care in patients with suspected coronary artery disease (CAD) would result in better mid- to long-term outcomes. In this patient population, anatomical testing with CCTA as the initial noninvasive diagnostic modality provided a lower risk of nonfatal myocardial infarction (MI) than usual care with functional testing, at the expense of more frequent use of invasive procedures.

Methods

• PubMed, Embase, and Cochrane Library were searched for randomized controlled trials comparing clinical outcomes during ≥ 6 months' follow-up between initial anatomical testing by CCTA vs usual care with functional testing in patients with suspected CAD.
• Researchers compared occurrence of all-cause mortality, nonfatal myocardial infarction (MI), and major adverse cardiovascular events (MACE), and use of invasive coronary angiography and coronary revascularization between the 2 diagnostic strategies.

Results

• This analysis included 12 trials (20 014 patients; mean follow-up, 20.5 months).
• Risk of nonfatal MI was lower in patients undergoing CCTA as initial noninvasive testing compared with those treated with usual care (risk ratio [RR]: 0.70, 95% confidence interval [CI]: 0.52-0.94, P = 0.02).
• Findings demonstrated that there was a tendency for reduced MACE following initial CCTA strategy, but not for risk of all-cause mortality.
• Researchers observed that, compared with functional testing, the CCTA strategy increased use of invasive coronary angiography (RR: 1.53, 95% CI: 1.12-2.09, P = 0.007) and coronary revascularization (RR: 1.49, 95% CI: 1.11-2.00, P = 0.007).