Aim: To compare outcomes of coronary computed tomography angiography (CCTA) with that of functional testing (FT) in stable coronary artery disease. Methods: We searched PubMed, Embase, and Cochrane for randomized controlled trials (RCTs). A random-effects meta-analysis targeting all-cause death and nonfatal acute coronary syndromes was performed. Results: Eight RCTs enrolling 29,579 patients were included. Pooled relative risk (RR) for the primary end point was similar between CCTA and FT (RR = 0.97; 95% CI: 0.76-1.22). CCTA outperformed FT in nonfatal myocardial infarction (MI) (RR = 0.59; 95% CI: 0.41-0.83) and in downstream testing (OR: 0.47; 95% CI: 0.21-1.01). Conclusion: Updated data of stable coronary artery disease suggests that CCTA improved nonfatal MI and downstream testing.
Keywords: coronary artery disease; coronary computed tomography angiography; myocardial infarction.
Coronary heart disease (narrowed or blocked arteries) can be diagnosed either by a functional testing or an anatomic testing. In functional testing, we will see if there is some reduced blood flow in the heart. In anatomic testing, a computerized tomography coronary angiogram is performed, to see the presence of atherosclerotic plaque (cholesterol) and the degree of obstruction. In this review, we provide an aerial view of the latest evidence on the best approach to coronary artery disease diagnosis. Updated evidence shows that a computerized tomography coronary angiogram reduced the risk of myocardial infarction and the need of further testing after an initial approach.