Overview with Meta-analysis of Systematic Reviews of the Diagnostic and Prognostic Value of Coronary Computed Tomography Angiography in the Emergency Department
Autor(a) principal: | |
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Data de Publicação: | 2018 |
Outros Autores: | , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | International Journal of Cardiovascular Sciences (Online) |
Texto Completo: | http://old.scielo.br/scielo.php?script=sci_arttext&pid=S2359-56472018000100033 |
Resumo: | Abstract Background: The high prevalence of CAD, as well as your impact on health expenditure and the various treatment options to reduce morbidity and mortality related to CAD, comes to develop a diagnostic tool precis and with important findings in the Emergency Department. Objetive: To conduct an overview with meta-analysis to compile evidence from multiple systematic reviews (SR) on the diagnostic and prognostic value of coronary computed tomography angiography (CCTA) to assess acute chest pain in the emergency department (ED). Methods: We included SR of primary studies that evaluated the diagnostic and prognostic value of CCTA ≥ 64 channels in the ED. The studies were conducted in patients at low and intermediate risk for coronary artery disease (CAD). Quality assessment was performed using PRISMA and approved reviews that scored ≥ 80%. Two authors independently extracted data using a standardized form. Spearman correlation test, Chi-square test, Cochran's Q test or Higgins and Thompson statistical I2 were used. For meta-analysis, "mada" package statistical software R Core Team, 2015, was used. The significance level adopted was 95%. Results: Four reviews were eligible for inclusion in this overview, resulting in 13 articles after applying the exclusion criteria, and only 10 of these were used for meta-analysis, adding up to a total of 4831 patients (mean age, 54 ± 6 years; 51% male), of whom 46% were hypertensive, 32% had dyslipidemia, 13% had diabetes and 26% had a family history of premature CAD. In the meta-analysis, 9 studies defined CCTA positive in the presence of luminal lesions ≥ 50%, while 1 study defined it as luminal lesions ≥ 70%. Sensitivity ranged from 77% to 98%, and specificity, from 73% to 100%. The univariate analysis showed homogeneity of diagnostic odds ratio (DOR) [Q = 8.5 (df = 9), p = 0.48 and I2 = 0%]. The pooled mean DOR for CCTA in primary analyses was 4.33 (95% CI: 3.47 - 5.18). The area under the curve (AUC) was 0.982 (95% CI: 0.967 - 0.999). There was no death, 29 (0.6%) infarcts, 92 (1.9%) revascularizations and 312 (6.4%) invasive coronary angiographies. The diagnosis of acute coronary syndrome occurred in 7.3% of the 1655 patients included in the meta-analysis. Conclusions: The use of CCTA as a tool for stratification of patients at low or intermediate cardiovascular risk, who are in the ED with chest pain, has high accuracy, safety, reduces length of hospital stay and probably the costs, producing an early diagnosis and more effective decision making. (Int J Cardiovasc Sci. 2017; [online].ahead print, PP.0-0) |
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International Journal of Cardiovascular Sciences (Online) |
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Overview with Meta-analysis of Systematic Reviews of the Diagnostic and Prognostic Value of Coronary Computed Tomography Angiography in the Emergency DepartmentCoronary Artery DiseaseTomography, X-Ray ComputedChest PainEmergency MedicineMeta-Analysis as TopicAbstract Background: The high prevalence of CAD, as well as your impact on health expenditure and the various treatment options to reduce morbidity and mortality related to CAD, comes to develop a diagnostic tool precis and with important findings in the Emergency Department. Objetive: To conduct an overview with meta-analysis to compile evidence from multiple systematic reviews (SR) on the diagnostic and prognostic value of coronary computed tomography angiography (CCTA) to assess acute chest pain in the emergency department (ED). Methods: We included SR of primary studies that evaluated the diagnostic and prognostic value of CCTA ≥ 64 channels in the ED. The studies were conducted in patients at low and intermediate risk for coronary artery disease (CAD). Quality assessment was performed using PRISMA and approved reviews that scored ≥ 80%. Two authors independently extracted data using a standardized form. Spearman correlation test, Chi-square test, Cochran's Q test or Higgins and Thompson statistical I2 were used. For meta-analysis, "mada" package statistical software R Core Team, 2015, was used. The significance level adopted was 95%. Results: Four reviews were eligible for inclusion in this overview, resulting in 13 articles after applying the exclusion criteria, and only 10 of these were used for meta-analysis, adding up to a total of 4831 patients (mean age, 54 ± 6 years; 51% male), of whom 46% were hypertensive, 32% had dyslipidemia, 13% had diabetes and 26% had a family history of premature CAD. In the meta-analysis, 9 studies defined CCTA positive in the presence of luminal lesions ≥ 50%, while 1 study defined it as luminal lesions ≥ 70%. Sensitivity ranged from 77% to 98%, and specificity, from 73% to 100%. The univariate analysis showed homogeneity of diagnostic odds ratio (DOR) [Q = 8.5 (df = 9), p = 0.48 and I2 = 0%]. The pooled mean DOR for CCTA in primary analyses was 4.33 (95% CI: 3.47 - 5.18). The area under the curve (AUC) was 0.982 (95% CI: 0.967 - 0.999). There was no death, 29 (0.6%) infarcts, 92 (1.9%) revascularizations and 312 (6.4%) invasive coronary angiographies. The diagnosis of acute coronary syndrome occurred in 7.3% of the 1655 patients included in the meta-analysis. Conclusions: The use of CCTA as a tool for stratification of patients at low or intermediate cardiovascular risk, who are in the ED with chest pain, has high accuracy, safety, reduces length of hospital stay and probably the costs, producing an early diagnosis and more effective decision making. (Int J Cardiovasc Sci. 2017; [online].ahead print, PP.0-0)Sociedade Brasileira de Cardiologia2018-02-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S2359-56472018000100033International Journal of Cardiovascular Sciences v.31 n.1 2018reponame:International Journal of Cardiovascular Sciences (Online)instname:Sociedade Brasileira de Cardiologia (SBC)instacron:SBC10.5935/2359-4802.20170086info:eu-repo/semantics/openAccessTavares,Irlaneide da SilvaMatos,Carlos José Oliveira deNunes,Marco Antonio PradoSousa,Antonio Carlos SobralLyra Júnior,Divaldo Pereira deOliveira,Joselina Luzia Menezeseng2018-05-10T00:00:00Zoai:scielo:S2359-56472018000100033Revistahttp://publicacoes.cardiol.br/portal/ijcshttps://old.scielo.br/oai/scielo-oai.phptailanerodrigues@cardiol.br||revistaijcs@cardiol.br2359-56472359-4802opendoar:2018-05-10T00:00International Journal of Cardiovascular Sciences (Online) - Sociedade Brasileira de Cardiologia (SBC)false |
dc.title.none.fl_str_mv |
Overview with Meta-analysis of Systematic Reviews of the Diagnostic and Prognostic Value of Coronary Computed Tomography Angiography in the Emergency Department |
title |
Overview with Meta-analysis of Systematic Reviews of the Diagnostic and Prognostic Value of Coronary Computed Tomography Angiography in the Emergency Department |
spellingShingle |
Overview with Meta-analysis of Systematic Reviews of the Diagnostic and Prognostic Value of Coronary Computed Tomography Angiography in the Emergency Department Tavares,Irlaneide da Silva Coronary Artery Disease Tomography, X-Ray Computed Chest Pain Emergency Medicine Meta-Analysis as Topic |
title_short |
Overview with Meta-analysis of Systematic Reviews of the Diagnostic and Prognostic Value of Coronary Computed Tomography Angiography in the Emergency Department |
title_full |
Overview with Meta-analysis of Systematic Reviews of the Diagnostic and Prognostic Value of Coronary Computed Tomography Angiography in the Emergency Department |
title_fullStr |
Overview with Meta-analysis of Systematic Reviews of the Diagnostic and Prognostic Value of Coronary Computed Tomography Angiography in the Emergency Department |
title_full_unstemmed |
Overview with Meta-analysis of Systematic Reviews of the Diagnostic and Prognostic Value of Coronary Computed Tomography Angiography in the Emergency Department |
title_sort |
Overview with Meta-analysis of Systematic Reviews of the Diagnostic and Prognostic Value of Coronary Computed Tomography Angiography in the Emergency Department |
author |
Tavares,Irlaneide da Silva |
author_facet |
Tavares,Irlaneide da Silva Matos,Carlos José Oliveira de Nunes,Marco Antonio Prado Sousa,Antonio Carlos Sobral Lyra Júnior,Divaldo Pereira de Oliveira,Joselina Luzia Menezes |
author_role |
author |
author2 |
Matos,Carlos José Oliveira de Nunes,Marco Antonio Prado Sousa,Antonio Carlos Sobral Lyra Júnior,Divaldo Pereira de Oliveira,Joselina Luzia Menezes |
author2_role |
author author author author author |
dc.contributor.author.fl_str_mv |
Tavares,Irlaneide da Silva Matos,Carlos José Oliveira de Nunes,Marco Antonio Prado Sousa,Antonio Carlos Sobral Lyra Júnior,Divaldo Pereira de Oliveira,Joselina Luzia Menezes |
dc.subject.por.fl_str_mv |
Coronary Artery Disease Tomography, X-Ray Computed Chest Pain Emergency Medicine Meta-Analysis as Topic |
topic |
Coronary Artery Disease Tomography, X-Ray Computed Chest Pain Emergency Medicine Meta-Analysis as Topic |
description |
Abstract Background: The high prevalence of CAD, as well as your impact on health expenditure and the various treatment options to reduce morbidity and mortality related to CAD, comes to develop a diagnostic tool precis and with important findings in the Emergency Department. Objetive: To conduct an overview with meta-analysis to compile evidence from multiple systematic reviews (SR) on the diagnostic and prognostic value of coronary computed tomography angiography (CCTA) to assess acute chest pain in the emergency department (ED). Methods: We included SR of primary studies that evaluated the diagnostic and prognostic value of CCTA ≥ 64 channels in the ED. The studies were conducted in patients at low and intermediate risk for coronary artery disease (CAD). Quality assessment was performed using PRISMA and approved reviews that scored ≥ 80%. Two authors independently extracted data using a standardized form. Spearman correlation test, Chi-square test, Cochran's Q test or Higgins and Thompson statistical I2 were used. For meta-analysis, "mada" package statistical software R Core Team, 2015, was used. The significance level adopted was 95%. Results: Four reviews were eligible for inclusion in this overview, resulting in 13 articles after applying the exclusion criteria, and only 10 of these were used for meta-analysis, adding up to a total of 4831 patients (mean age, 54 ± 6 years; 51% male), of whom 46% were hypertensive, 32% had dyslipidemia, 13% had diabetes and 26% had a family history of premature CAD. In the meta-analysis, 9 studies defined CCTA positive in the presence of luminal lesions ≥ 50%, while 1 study defined it as luminal lesions ≥ 70%. Sensitivity ranged from 77% to 98%, and specificity, from 73% to 100%. The univariate analysis showed homogeneity of diagnostic odds ratio (DOR) [Q = 8.5 (df = 9), p = 0.48 and I2 = 0%]. The pooled mean DOR for CCTA in primary analyses was 4.33 (95% CI: 3.47 - 5.18). The area under the curve (AUC) was 0.982 (95% CI: 0.967 - 0.999). There was no death, 29 (0.6%) infarcts, 92 (1.9%) revascularizations and 312 (6.4%) invasive coronary angiographies. The diagnosis of acute coronary syndrome occurred in 7.3% of the 1655 patients included in the meta-analysis. Conclusions: The use of CCTA as a tool for stratification of patients at low or intermediate cardiovascular risk, who are in the ED with chest pain, has high accuracy, safety, reduces length of hospital stay and probably the costs, producing an early diagnosis and more effective decision making. (Int J Cardiovasc Sci. 2017; [online].ahead print, PP.0-0) |
publishDate |
2018 |
dc.date.none.fl_str_mv |
2018-02-01 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S2359-56472018000100033 |
url |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S2359-56472018000100033 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
10.5935/2359-4802.20170086 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
dc.publisher.none.fl_str_mv |
Sociedade Brasileira de Cardiologia |
publisher.none.fl_str_mv |
Sociedade Brasileira de Cardiologia |
dc.source.none.fl_str_mv |
International Journal of Cardiovascular Sciences v.31 n.1 2018 reponame:International Journal of Cardiovascular Sciences (Online) instname:Sociedade Brasileira de Cardiologia (SBC) instacron:SBC |
instname_str |
Sociedade Brasileira de Cardiologia (SBC) |
instacron_str |
SBC |
institution |
SBC |
reponame_str |
International Journal of Cardiovascular Sciences (Online) |
collection |
International Journal of Cardiovascular Sciences (Online) |
repository.name.fl_str_mv |
International Journal of Cardiovascular Sciences (Online) - Sociedade Brasileira de Cardiologia (SBC) |
repository.mail.fl_str_mv |
tailanerodrigues@cardiol.br||revistaijcs@cardiol.br |
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1754732624860938240 |