Coronary CT Angiography vs. Stress Testing: Meta-Analysis Offers Mixed Results

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

In patients with suspected coronary artery disease (CAD), coronary computed tomography angiography (CCTA) is associated with lower risk for myocardial infarction — but no mortality benefit — when compared with standard functional testing. The findings appear in JAMA Internal Medicine.

Researchers examined data from 13 trials in which 20,000 patients with stable or acute chest pain were randomized to either CCTA or functional stress testing. Among the findings, during roughly 18 months' follow-up:

• Neither mortality nor cardiac hospitalizations differed between the groups.

• MI occurred significantly less often with CCTA versus functional testing (0.7% vs. 1.1%).

• CCTA was associated with more invasive coronary angiography procedures (12% vs. 9%), revascularizations (7% vs. 5%), CAD diagnoses (18% vs. 8%), and aspirin and statin prescriptions.

Commentators say the findings "demonstrate that CCTA should be more broadly available to patients without known CAD" who present with chest pain. They note, however, that CCTA's benefits "are likely largely driven by changes in preventive therapies."