Non-invasive assessment of low risk acute chest pain in the emergency department

A comparative meta-analysis of prospective studies

Jorge E. Romero, S. Arman Husain, Anthony A. Holmes, Iosif Kelesidis, Patricia Chavez, M. Khalid Mojadidi, Jeffrey M. Levsky, Omar Wever-Pinzon, Cynthia C. Taub, Harikrishna Makani, Mark I. Travin, Ileana L. Pina, Mario J. Garcia

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: The aim of this meta-analysis was to compare the diagnostic accuracy of cardiac computed tomographic angiography (CCTA), stress echocardiography (SE) and radionuclide single photon emission computed tomography (SPECT) for the assessment of chest pain in emergency department (ED) setting. Methods: A systematic review of Medline, Cochrane and Embase was undertaken for prospective clinical studies assessing the diagnostic efficacy of CCTA, SE or SPECT, as compared to intracoronary angiography (ICA) or the later presence of major adverse clinical outcomes (MACE), in patients presenting to the ED with chest pain. Standard approach and bivariate analysis were performed. Results: Thirty-seven studies (15 CCTA, 9 SE, 13 SPECT) comprising a total of 7800 patients fulfilled inclusion criteria. The respectiveweightedmean sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and total diagnostic accuracy for CCTA were: 95%, 99%, 84%, 100% and 99%, for SE were: 84%, 94%, 73%, 96% and 96%, and for SPECT were: 85%, 86%, 57%, 95% and 88%. There was no significant difference between modalities in terms of NPV. Bivariate analysis revealed that CCTA had statistically greater sensitivity, specificity, PPV and overall diagnostic accuracy when compared to SE and SPECT. Conclusions: All three modalities, when employed by an experienced clinician, are highly accurate. Each has its own strengths and limitations making each well suited for different patient groups. CCTA has higher accuracy than SE and SPECT, but it has many drawbacks, most importantly its lack of physiologic data.

Original languageEnglish (US)
Pages (from-to)565-580
Number of pages16
JournalInternational Journal of Cardiology
Volume187
Issue number1
DOIs
StatePublished - May 6 2015

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Stress Echocardiography
Acute Pain
Chest Pain
Meta-Analysis
Hospital Emergency Service
Single-Photon Emission-Computed Tomography
Angiography
Prospective Studies
Sensitivity and Specificity

Keywords

  • Coronary computed tomographic angiography
  • Meta-analysis
  • Non-invasive chest pain assessment
  • Single-photon emission computed tomography
  • Stress echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Non-invasive assessment of low risk acute chest pain in the emergency department : A comparative meta-analysis of prospective studies. / Romero, Jorge E.; Husain, S. Arman; Holmes, Anthony A.; Kelesidis, Iosif; Chavez, Patricia; Mojadidi, M. Khalid; Levsky, Jeffrey M.; Wever-Pinzon, Omar; Taub, Cynthia C.; Makani, Harikrishna; Travin, Mark I.; Pina, Ileana L.; Garcia, Mario J.

In: International Journal of Cardiology, Vol. 187, No. 1, 06.05.2015, p. 565-580.

Research output: Contribution to journalArticle

Romero, Jorge E. ; Husain, S. Arman ; Holmes, Anthony A. ; Kelesidis, Iosif ; Chavez, Patricia ; Mojadidi, M. Khalid ; Levsky, Jeffrey M. ; Wever-Pinzon, Omar ; Taub, Cynthia C. ; Makani, Harikrishna ; Travin, Mark I. ; Pina, Ileana L. ; Garcia, Mario J. / Non-invasive assessment of low risk acute chest pain in the emergency department : A comparative meta-analysis of prospective studies. In: International Journal of Cardiology. 2015 ; Vol. 187, No. 1. pp. 565-580.
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T1 - Non-invasive assessment of low risk acute chest pain in the emergency department

T2 - A comparative meta-analysis of prospective studies

AU - Romero, Jorge E.

AU - Husain, S. Arman

AU - Holmes, Anthony A.

AU - Kelesidis, Iosif

AU - Chavez, Patricia

AU - Mojadidi, M. Khalid

AU - Levsky, Jeffrey M.

AU - Wever-Pinzon, Omar

AU - Taub, Cynthia C.

AU - Makani, Harikrishna

AU - Travin, Mark I.

AU - Pina, Ileana L.

AU - Garcia, Mario J.

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N2 - Background: The aim of this meta-analysis was to compare the diagnostic accuracy of cardiac computed tomographic angiography (CCTA), stress echocardiography (SE) and radionuclide single photon emission computed tomography (SPECT) for the assessment of chest pain in emergency department (ED) setting. Methods: A systematic review of Medline, Cochrane and Embase was undertaken for prospective clinical studies assessing the diagnostic efficacy of CCTA, SE or SPECT, as compared to intracoronary angiography (ICA) or the later presence of major adverse clinical outcomes (MACE), in patients presenting to the ED with chest pain. Standard approach and bivariate analysis were performed. Results: Thirty-seven studies (15 CCTA, 9 SE, 13 SPECT) comprising a total of 7800 patients fulfilled inclusion criteria. The respectiveweightedmean sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and total diagnostic accuracy for CCTA were: 95%, 99%, 84%, 100% and 99%, for SE were: 84%, 94%, 73%, 96% and 96%, and for SPECT were: 85%, 86%, 57%, 95% and 88%. There was no significant difference between modalities in terms of NPV. Bivariate analysis revealed that CCTA had statistically greater sensitivity, specificity, PPV and overall diagnostic accuracy when compared to SE and SPECT. Conclusions: All three modalities, when employed by an experienced clinician, are highly accurate. Each has its own strengths and limitations making each well suited for different patient groups. CCTA has higher accuracy than SE and SPECT, but it has many drawbacks, most importantly its lack of physiologic data.

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KW - Meta-analysis

KW - Non-invasive chest pain assessment

KW - Single-photon emission computed tomography

KW - Stress echocardiography

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