A meta-analysis and systematic review of computed tomography angiography as a diagnostic triage tool for patients with chest pain presenting to the emergency department

作者：Samad Zainab^*; Hakeem Abdul; Mahmood Syed Shad; Pieper Karen; Patel Manesh R; Simel David L; Douglas Pamela S

来源：Journal of Nuclear Cardiology, 2012, 19(2): 364-376.

DOI：10.1007/s12350-012-9520-2

• Computed tomography (CT)
• acute coronary syndromes
• diagnostic and prognostic application
• emergency department
• chest pain

Background. To assess clinical utility of computed tomography angiography (CTA) in the diagnosis of chest pain patients presenting to emergency departments (EDs), we conducted a meta-analysis of CTA in patients with suspected acute coronary syndromes (ACSs).
Methods. 386 studies were identified on initial review of literature. Inclusion criteria were: (1) prospective study with >= 1 month follow-up, (2) use of CTA in the ED setting, (3) use of ACC/AHA definitions for ACS and robust assessment of major adverse cardiac events, (4) >= 30 patients, and (5) study population with initial non-diagnostic ECGs and negative biomarkers.
Results. Nine studies (N = 1349) formed the data set. The pooled patient population was 52 +/- 2 years of age, 51% male, with low to intermediate pretest probability for ACS. Risk factors included 12% diabetes, 42% hypertension, 35% smokers, 29% had hyperlipidemia, and 7% known CAD. ACS was subsequently diagnosed in 10% of patients. The bivariate summary estimate of sensitivity of CTA for ACS diagnosis was 95% (95% CI 88-100) and specificity was 87% (95% CI 83-92), yielding a negative likelihood ratio of 0.06 (95% CI 0-0.14) and positive likelihood ratio of 7.4 (95% CI 4.8-10). The 30-day event rate included no deaths and no additional MIs.
Conclusion. Coronary CTA demonstrates a high sensitivity and a low negative likelihood ratio of 0.06, and is effective in ruling out the presence of ACS in low to intermediate risk patients presenting to the ED with acute chest pain.

• 出版日期2012-4