Foy AJ, et al. - The clinical efficacy of coronary computed tomography angiography (CCTA) with that of functional stress testing for patients with suspected coronary artery disease (CAD) is compared in this study. Compared with functional stress testing, CCTA is related to a decreased incidence of myocardial infarction but an increased incidence of invasive coronary angiography, revascularization, CAD diagnoses, and new prescriptions for aspirin and statins. Despite these differences, CCTA is not related to a reduction in mortality or cardiac hospitalizations.

Methods

• For this study, they designed a systematic literature search.
• This study was conducted in PubMed and MEDLINE for English-dialect randomized clinical trials of CCTA published from January 1, 2000, to July 10, 2016.
• Researchers selected randomized clinical trials that compared a primary strategy of CCTA with that of functional stress testing for patients with suspected CAD and reported data on patient clinical events and changes in therapy.
• Two reviewers independently extracted data from and evaluated the quality of the trials.
• This analysis followed the PRISMA statement for reporting systematic reviews and meta-analyses and utilized the Cochrane Collaboration’s tool for evaluating the risk of bias in randomized trials.
• The Mantel-Haenszel method was utilized to conduct the primary examination.
• Summary relative risks were ascertained with a random-effects model.

Results

• In this study, they included thirteen trials with 10315 patients in the CCTA arm and 9777 patients in the functional stress testing arm who were followed up for a mean duration of 18 months.
• No statistically significant differences were seen between CCTA and functional stress testing in death (1.0% vs 1.1%; risk ratio [RR], 0.93; 95% CI, 0.71-1.21) or cardiac hospitalization (2.7% vs 2.7%; RR, 0.98; 95% CI, 0.79-1.21), but CCTA was related to a reduction in the incidence of myocardial infarction (0.7% vs 1.1%; RR, 0.71; 95% CI, 0.53-0.96).
• Patients undergoing CCTA were significantly more likely to undergo invasive coronary angiography (11.7% vs 9.1%; RR, 1.33; 95% CI, 1.12-1.59) and revascularization (7.2% vs 4.5%; RR, 1.86; 95% CI, 1.43-2.43).
• They were also more likely to receive a diagnosis of new CAD and to have initiated aspirin or statin therapy.