Diagnostic Strategies for the Assessment of Suspected Stable Coronary Artery Disease

When it comes to detecting coronary artery disease (CAD), there is a lack of consensus regarding the most effective diagnostic strategy. To address this uncertainty, researchers conducted a comprehensive analysis to compare different diagnostic approaches for the initial assessment of suspected stable CAD and evaluate their impact on clinical management and subsequent health outcomes. The study examined randomized clinical trials that compared various diagnostic strategies for CAD detection among patients with symptoms suggestive of stable CAD, utilizing data from PubMed, Embase, and the Cochrane Central Register of Controlled Trials.

Among the six comparisons analyzed, the strongest evidence was found for three specific comparisons: coronary computed tomography angiography (CCTA) versus invasive coronary angiography (ICA), CCTA versus exercise electrocardiography (ECG), and CCTA versus stress single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI). When compared with direct ICA referral, CCTA was associated with similar rates of cardiovascular death and myocardial infarction but resulted in fewer index ICA and index revascularization procedures. Additionally, CCTA demonstrated a reduction in cardiovascular death and myocardial infarction when compared to exercise ECG and SPECT-MPI. However, it was linked to a higher number of index revascularization procedures and a lower need for downstream testing compared to exercise ECG. The available evidence for other comparisons was limited, and most comparisons relied on data from a single study, potentially impacting the statistical power and precision of the findings...Read more