CT angiography compared to invasive angiography for stable coronary disease as predictors of major adverse cardiovascular events- A systematic review and meta-analysis
Natasha Corballis, Vasiliki Tsampasian, Ioannis Merinopoulis, Tharusha Gunawardena, U Bhalraam, Simon Eccleshall, Marc R. Dweck, Vassilios S. Vassiliou
Abstract
BackgroundComputational tomography coronary angiography (CTCA) is increasingly the diagnostic test of choice for investigating patients with stable anginal symptoms.ObjectivesWe sought to conduct a systematic review and meta-analysis comparing CTCA with invasive coronary angiography (ICA) with regards to major adverse cardiovascular events (MACE), procedural complications and rates of revascularisation.MethodsWe conducted a systematic review and meta-analysis in line with the PRISMA statement. A literature search was conducted using PubMed, MEDLINE Ovid and Embase, with three studies included in meta-analysis. Statistical analysis was undertaken using Review Manager 5.3 for MacOS software and outcomes expressed as odds ratio, with 95% confidence intervals and sensitivity analysis was conducted.ResultsA total of 5662 patients were included in this study level meta-analysis. There was no difference in MACE between CT and angiography [2.97% v 3.45%, fixed-effect model, OR: 0.84 (0.62–1.14), p = 0.26, I2 0%] and no difference found in rates of myocardial infarction, death or stroke. CTCA was associated with a reduced rate of revascularisation [12.6% v 18.3%, fixed-effects model, OR: 0.64 (0.55–0.75), p<0.00001, I2 =0%]. However, CTCA was not associated with a significantly lower complication rate [0.5% v 1.72%, random effects model, OR: 0.52 (0.06–4.38), p = 0.55, I2 52%].ConclusionCTCA is a safe strategy for investigating patients with stable angina with no associated increase in MACE but a reduction in revascularisation rates.