Ascertaining the Best Initial Strategy for Evaluation of Stable Chest Pain

Background: We have many non-invasive techniques for evaluating chest pain to help select patients for invasive testing, ie, invasive coronary angiography (ICA). Broadly defined, they are structural versus functional methods. Which are the best methods for predicting the subsequent need for invasive testing and predicting morbidity and mortality? Objective: To assess alternative diagnostic strategies for the initial assessment of patients with symptoms suggestive of stable coronary artery disease (CAD) as to their effect on clinical management and outcomes. Design: Systematic review and meta-analysis. Methods: The authors chose randomized controlled trials that compared testing strategies and had clinical outcomes data in patients with symptomatic but stable chest pain and without known CAD. A total of 15 trials qualified. The calculated pretest risk of CAD was 33.8% to 53.3%. Results: (1) For coronary CT angiography (CCTA) versus standard ICA (4 trials; 5752 patients): risks of myoc more...