Abstract

Introduction

Multiple Randomised Control Trials have proven the usefulness of CCTA (Coronary CT Angiography) as a non-invasive diagnostic procedure in Coronary Artery Disease (CAD) management. However, its superiority over the standard care approach remains to be established. Hence, it was important to address the impact of CCTA on clinical care and downstream resource utilization.

Methods

A total of 18 RCTs having 12,104 patients in the CCTA arm and 11,026 patients in the Standard of Care (SOC) arm following PRISMA guidelines till October 2019 were matched for inclusion and exclusion criteria. Following this, CCTA and standard care approaches were evaluated for coronary revascularization, downstream testing and safety outcomes. RevMan 5.3 was used for appropriate statistical tests. Fixed and Random Effect Model Test were used and p<0.05 was considered statistically significant.

Results

Coronary computed tomography angiography (CCTA) was associated with a significant increase in revascularizations (RR =1.401, 95% CI =1.315-1.492, p<0.001) as well as invasive coronary angiography procedures (RR =1.304, 95% CI =1.208-1.409, p<0.001) and decreased incidence of MI (RR =0.752, 95% CI =0.578-1.409, p<0.033) down the line as compared to standard care approaches. However, there was no significant association with all-cause mortality. 

Conclusion

We recommend CCTA over standard care approaches in evaluating Coronary Artery Disease due to its impact on reducing morbidity of patients with time.