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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.

Publication ,  Journal Article
Samad, Z; Hakeem, A; Mahmood, SS; Pieper, K; Patel, MR; Simel, DL; Douglas, PS
Published in: J Nucl Cardiol
April 2012

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.

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Published In

J Nucl Cardiol

DOI

EISSN

1532-6551

Publication Date

April 2012

Volume

19

Issue

2

Start / End Page

364 / 376

Location

United States

Related Subject Headings

  • Triage
  • Tomography, X-Ray Computed
  • Sensitivity and Specificity
  • Risk Factors
  • Risk Assessment
  • Reproducibility of Results
  • Prevalence
  • Humans
  • Emergency Medical Services
  • Coronary Angiography
 

Citation

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Samad, Z., Hakeem, A., Mahmood, S. S., Pieper, K., Patel, M. R., Simel, D. L., & Douglas, P. S. (2012). 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. J Nucl Cardiol, 19(2), 364–376. https://doi.org/10.1007/s12350-012-9520-2
Samad, Zainab, Abdul Hakeem, Syed Shad Mahmood, Karen Pieper, Manesh R. Patel, David L. Simel, and Pamela S. Douglas. “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.J Nucl Cardiol 19, no. 2 (April 2012): 364–76. https://doi.org/10.1007/s12350-012-9520-2.
Samad, Zainab, et al. “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.J Nucl Cardiol, vol. 19, no. 2, Apr. 2012, pp. 364–76. Pubmed, doi:10.1007/s12350-012-9520-2.
Samad Z, Hakeem A, Mahmood SS, Pieper K, Patel MR, Simel DL, Douglas PS. 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. J Nucl Cardiol. 2012 Apr;19(2):364–376.
Journal cover image

Published In

J Nucl Cardiol

DOI

EISSN

1532-6551

Publication Date

April 2012

Volume

19

Issue

2

Start / End Page

364 / 376

Location

United States

Related Subject Headings

  • Triage
  • Tomography, X-Ray Computed
  • Sensitivity and Specificity
  • Risk Factors
  • Risk Assessment
  • Reproducibility of Results
  • Prevalence
  • Humans
  • Emergency Medical Services
  • Coronary Angiography