Introduction
Coronary artery disease (CAD) is the leading cause of death in Australia. Rural populations bear a higher burden of CAD and associated mortality. This burden increases with increasing remoteness. Computed tomography coronary angiography (CTCA) is a non-invasive imaging technique that provides the opportunity for early diagnosis of CAD in regional Australia where it is readily available. This is a literature review of the diagnostic accuracy and outcomes of CTCA.
Aim
To perform a systematic review of the literature assessing diagnostic accuracy and clinical outcomes for CTCA.
Method/Description
Reviewers conducted a systematic review for relevant articles between 2000-2022. Studies included presented data relating to diagnostic accuracy of CTCA in comparison to alternative techniques such as conventional angiography and outcomes post-CTCA.
Results
Initial searches yielded 213 studies assessing clinical outcomes post-CTCA, and 84 assessing diagnostic accuracy. Following review of titles and abstracts, 18 studies were included. CTCA was found to have high negative predictive value, similar to conventional angiography in ability to identify patients requiring subsequent revascularisation. Diagnostic use is more limited with severe coronary artery calcification. CTCA resulted in lower risk of long-term complications including non-fatal myocardial infarction (MI) and death. Risk varied with calcium score and period of follow-up. Datasets included were heterogenous.
Consclusions
This review showed that CTCA allows for early diagnosis of CAD and is associated with significantly lower risk of death and non-fatal (MI). Patients with a calcium score of 0 have the lowest mortality rates independent of scores such as the Framingham risk score.