Diagnostic Strategies for the Assessment of Suspected Stable Coronary Artery Disease : A Systematic Review and Meta-analysis
An erratum to this article was published (Ann Intern Med, Jul 2024 ↗)
Authors' conclusion
For the initial assessment of patients with suspected stable CAD, CCTA was associated with similar health effects to direct ICA referral, and with a health benefit compared with exercise ECG and SPECT-MPI.
Study context
- Population
- Patients with symptoms suggestive of stable coronary artery disease (CAD)
- Comparison
- Alternative diagnostic strategies for initial assessment of suspected stable CAD (coronary computed tomography angiography (CCTA) vs invasive coronary angiography (ICA), exercise electrocardiography (ECG), single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI))
- Outcome
- CV death and MI
Pooled result
As reported in the abstract
Relative risk (95% CI)
CCTA vs ICA4 trials; low certainty
0.84(0.52–1.35)
CCTA vs Exercise ECG2 trials; moderate certainty
0.66(0.44–0.99)
CCTA vs SPECT-MPI5 trials; high certainty
0.64(0.45–0.90)
Further pooled results
| Outcome | RR (95% CI) | |
|---|---|---|
| Index ICACCTA vs ICA · high certainty | 0.23 (0.22–0.25) | |
| Index revascularizationCCTA vs ICA · moderate certainty | 0.71 (0.63–0.80) | |
| Index revascularizationCCTA vs Exercise ECG · moderate certainty | 1.78 (1.33–2.38) | |
| Downstream testingCCTA vs Exercise ECG · very low certainty | 0.56 (0.45–0.71) | |
| 0.20.5125Relative risk (log scale) |
Original publication
Diagnostic Strategies for the Assessment of Suspected Stable Coronary Artery Disease : A Systematic Review and Meta-analysis. Ann Intern Med. Published 6 June 2023. doi:10.
Summarised from the published abstract; every number is checked against it