CCTA vs Stress Testing: Which is Better for CAD?

Coronary computed tomography angiography (CCTA) was associated with a reduced incidence of myocardial infarction compared with functional stress testing among patients with suspected coronary artery disease (CAD), according to a recent meta-analysis. However, CCTA increased the use of secondary preventions, including invasive procedures, some of which may have been unnecessary.

For their systematic review and meta-analysis, the researchers searched PubMed and MEDLINE for randomized clinical trials that compared the effectiveness of CCTA with functional stress testing for patients with suspected CAD published from January 1, 2000 through July 10, 2016. The primary outcomes included all-cause mortality, cardiac hospitalization, myocardial infarction, invasive coronary angiography, coronary revascularization, new CAD diagnosis, and changes in aspirin and statin prescriptions. Additionally, the researchers used random-effects models to calculate relative risk ratios (RR).
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The analysis included 13 studies and a total of 10,315 patients who underwent CCTA and 9777 patients who underwent functional stress testing. The mean follow-up time was 18 months. 

Overall, the studies showed no statistically significant differences between CCTA and functional stress testing for mortality (1.0% vs 1.1%; RR 0.93) or cardiac hospitalization (2.7% vs 2.7%; RR 0.98). However, the researchers found that CCTA was associated with a reduced incidence of myocardial infarction (0.7% vs 1.1%; RR 0.71).

In addition, patients who underwent CCTA were significantly more likely to underdo invasive coronary angiography (11.7% vs 9.1%, RR 1.33) and revascularization (7.2% vs 4.5%, RR1.86) compared with those who underwent stress testing. Additionally, those who underwent CCTA were more likely to receive a new CAD diagnosis or initiate statin or aspirin therapy.

“Compared with functional stress testing, CCTA is associated with a reduced incidence of myocardial infarction but an increased incidence of invasive coronary angiography, revascularization, CAD diagnoses, and new prescriptions for aspirin and statins,” the researchers concluded. “Despite these differences, CCTA is not associated with a reduction in mortality or cardiac hospitalizations.”

—Melissa Weiss

Reference:

Foy AJ, Dhruva SS, Peterson B, Mandrola JM, Morgan DJ, Redberg RF. Coronary computed tomography angiography vs functional stress testing for patients with suspected coronary artery disease: a systematic review and meta-analysis [published online October 2, 2017]. JAMA Intern Med. doi:10.1001/jamainternmed.2017.4772.