Outcomes after coronary computed tomography angiography in the emergency department: a systematic review and meta-analysis of randomized, controlled trials

J Am Coll Cardiol. 2013 Feb 26;61(8):880-92. doi: 10.1016/j.jacc.2012.11.061. Epub 2013 Feb 6.


Objectives: The aim of the study was to systematically review and perform a meta-analysis of randomized, controlled trials of coronary computed tomography angiography (CCTA) versus usual care (UC) triage of acute chest pain in the emergency department (ED).

Background: CCTA allows rapid evaluation of patients presenting to the ED with acute chest pain syndromes; however, the impact of such testing on patient management and downstream testing has emerged as a concern.

Methods: We systematically searched for randomized, controlled trials of CCTA in the ED and performed a meta-analysis of clinical outcomes.

Results: Four randomized, controlled trials were included, with 1,869 patients undergoing CCTA and 1,397 undergoing UC. There were no deaths and no difference in the incidence of myocardial infarction, post-discharge ED visits, or rehospitalizations. Four studies reported decreased length of stay with CCTA and 3 reported cost savings; 8.4% of patients undergoing CCTA versus 6.3% of those receiving UC underwent invasive coronary angiography (ICA), whereas 4.6% of patients undergoing CCTA versus 2.6% of those receiving UC underwent coronary revascularization. The odds ratio of ICA for CCTA patients versus UC patients was 1.36 (95% confidence interval [CI]: 1.03 to 1.80, p = 0.030), and for revascularization, it was 1.81 (95% CI: 1.20 to 2.72, p = 0.004). The absolute increase in ICA after CCTA was 21 per 1,000 CCTA patients (95% CI: 1.8 to 44.9), and the number needed to scan was 48. The absolute increase in revascularization after CCTA was 20 per 1,000 patients (95% CI: 5.0 to 41.4); the number needed to scan was 50. Both percutaneous coronary intervention and coronary artery bypass graft surgery independently contributed to the significant increase in revascularization.

Conclusions: Compared with UC, the use of CCTA in the ED is associated with decreased ED cost and length of stay but increased ICA and revascularization.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Chest Pain* / diagnosis
  • Chest Pain* / etiology
  • Chest Pain* / therapy
  • Comparative Effectiveness Research
  • Coronary Angiography* / methods
  • Coronary Angiography* / statistics & numerical data
  • Coronary Artery Bypass / statistics & numerical data
  • Cost Savings
  • Emergency Service, Hospital* / economics
  • Emergency Service, Hospital* / standards
  • Emergency Service, Hospital* / statistics & numerical data
  • Humans
  • Length of Stay / statistics & numerical data
  • Myocardial Infarction* / complications
  • Myocardial Infarction* / diagnosis
  • Myocardial Infarction* / mortality
  • Myocardial Infarction* / therapy
  • Patient Readmission / statistics & numerical data
  • Percutaneous Coronary Intervention / statistics & numerical data
  • Randomized Controlled Trials as Topic
  • Survival Analysis
  • Tomography, X-Ray Computed* / methods
  • Tomography, X-Ray Computed* / statistics & numerical data
  • Triage / methods
  • Triage / statistics & numerical data