Author + information
- Georgios Siontis,
- Dimitris Mavridis,
- Konstantinos Siontis,
- Bernadette Coles,
- Peter Jüni,
- Georgia Salanti and
- Stephan Windecker
Background: The comparative effects of non-invasive imaging on management and clinical outcomes in low-risk acute coronary syndromes (ACS) patients remain unclear.
Methods: We performed a random-effects network meta-analysis to obtain estimates of relative effectiveness of non-invasive diagnostic strategies in low-risk ACS. We focused on downstream invasive coronary angiography (ICA), revascularization, and myocardial infarction (MI) from published reports of diagnostic randomized controlled trials (D-RCT). Estimates are expressed as odds ratios (OR) and 95% confidence intervals (CI).
Results: We identified 18 D-RCT with 11,329 patients randomly assigned to 6 diagnostic strategies (exercise ECG, stress echocardiography, myocardial perfusion imaging (MPI), cardiac magnetic resonance (CMR), coronary computed tomographic angiography (CCTA), standard care). Patients initially evaluated by means of stress echocardiography were less likely to be referred to ICA compared to exercise ECG (0.51 (0.35-0.75)), MPI (0.35 (0.17-0.74)), standard of care (0.32 (0.16-0.65)), and CCTA (0.27 (0.13-0.56)), whereas there was no difference compared with CMR (0.84 (0.30-2.37)). A lower rate of downstream ICA was also observed among patients randomly assigned to CMR compared with CCTA (0.32 (0.15-0.71)). We did not detect differences between direct and indirect evidence in the network. Regarding subsequent revascularization, patients evaluated by means of CMR were less likely to undergo revascularization followed by those assessed by stress echocardiography. Fewer revascularization procedures were observed among patients who initially underwent CMR, MPI, and standard care compared to CCTA (0.17 (0.04-0.65), 0.57 (0.41-0.79), and 0.68 (0.53-0.88) respectively). Despite the differences detected among the diagnostic modalities in referrals to ICA and revascularization, none of the strategies impacted the rate of MI, which was a low frequency event.
Conclusions: In patients with suspected low-risk ACS, a diagnostic strategy of initial functional testing is associated with fewer referrals for downstream ICA and revascularization, without apparent impact on the subsequent risk of MI.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Unusual Presentations of ACS
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1297-337
- 2017 American College of Cardiology Foundation