Author + information
- Andrew J. Foy,
- Sanket Dhruva,
- Brandon Peterson,
- Daniel Morgan,
- John Mandrola and
- Rita Redberg
Background: Trial sequential analysis (TSA) can establish when firm evidence is reached in meta-analyses. We performed TSA to assess the efficacy of coronary CT angiography (CCTA) versus standard care (SC).
Methods: We evaluated the endpoints of death plus MI, MI alone, cardiac hospitalization, invasive coronary angiography (ICA) and revascularization in the 12 published RCTs comparing CCTA to SC, which generally included functional testing, for the assessment of patients with suspected CAD. The Mantel-Haenszel method with random effects models was used to calculate odds ratios. TSA was performed with a α error of 5%. Monitoring boundaries were constructed according to the required information size to detect 25% or 40% relative risk reductions (RRRs) based on the control group's incidence, with a β error of 20%.
Results: CCTA did not significantly reduce the composite endpoint of death plus MI (OR 0.87; 95% CI 0.68-1.10), MI (OR 0.75; 0.51-1.09), or cardiac hospitalization (OR 0.94; 0.68-1.29). TSA excludes (crosses futility boundary) a 25% RRR in death plus MI (ARR 0.45%) and cardiac hospitalization (ARR 0.6%) and a 40% RRR in MI alone (ARR 0.32%; Figure) compared to SC. CCTA significantly increased ICA (OR 1.5; 1.31-1.72) and revascularization (OR 2.06; 1.76-2.41); TSA confirms these effects with high confidence.
Conclusions: CCTA significantly increases ICA and revascularization without reducing cardiac events compared to SC. CAD is best diagnosed on the basis of clinical and functional assessment.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Traditional and Novel Factors Used to Assess the Risk of, and Used for the Treatment of, Coronary Artery Disease
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1126-328
- 2017 American College of Cardiology Foundation