Olivetti L, Mazza G, Volpi D, Costa F, Ferrari O, Pirelli S. 64-Slice CT coronary angiography in patients with non-ST elevation acute coronary syndrome. Meijboom WB, Mollet NR, Van Mieghem CA, Weustink AC, Pugliese F, van Pelt N, et al. Detection of non-ST-elevation myocardial infarction and unstable angina in the acute setting: Meta-analysis of diagnostic performance of multi-detector computed tomographic angiography. Vanhoenacker PK, Decramer I, Bladt O, Sarno G, Bevernage C, Wijns W. Use of multidetector computed tomography for the assessment of acute chest pain: A consensus statement of the North American Society of Cardiac Imaging and the European Society of Cardiac Radiology. Stillman AE, Oudkerk M, Ackerman M, Becker CR, Buszman PE, de Feyter PJ, et al. Usefulness of 64-slice cardiac computed tomographic angiography for diagnosing acute coronary syndromes and predicting clinical outcome in emergency department patients with chest pain of uncertain origin. Rubinshtein R, Halon DA, Gaspar T, Jaffe R, Karkabi B, Flugelman MY, et al. 64-Slice CT for diagnosis of coronary artery disease: A systematic review. Stein PD, Yaekoub AY, Matta F, Sostman HD. Diagnostic performance of coronary angiography by 64-row CT. Risk stratification of patients with acute chest pain and normal troponin concentrations. Sanchis J, Bodi V, Llacer A, Nunez J, Consuegra L, Bosch MJ, et al. Assessment of patients with low-risk chest pain in the emergency department: Head-to-head comparison of exercise stress echocardiography and exercise myocardial SPECT. J Am Coll Cardiol 2002 40:251-6.Д¬onti A, Sammicheli L, Gallini C, Costanzo EN, Antoniucci D, Barletta G. Immediate exercise testing to evaluate low-risk patients presenting to the emergency department with chest pain. N Engl J Med 2000 342:1163-70.ДЄmsterdam EA, Kirk JD, Diercks DB, Lewis WR, Turnipseed SD. Missed diagnoses of acute cardiac ischemia in the emergency department. Pope JH, Aufderheide TP, Ruthazer R, Woolard RH, Feldman JA, Beshansky JR, et al. Impact on the care of the emergency department chest pain patient from the chest pain evaluation registry (CHEPER) study. Graff LG, Dallara J, Ross MA, Joseph AJ, Itzcovitz J, Andelman RP, et al. An evaluation of technologies for identifying acute cardiac ischemia in the emergency department: A report from a National Heart Attack Alert Program Working Group. Selker HP, Zalenski RJ, Antman EM, Aufderheide TP, Bernard SA, Bonow RO, et al. ConclusionД¬oronary CTA demonstrates a high sensitivity and a low negative likelihood ratio of 0.06, and is effective in ruling out the presence of ACS in low to intermediate risk patients presenting to the ED with acute chest pain. The 30-day event rate included no deaths and no additional MIs. The bivariate summary estimate of sensitivity of CTA for ACS diagnosis was 95% (95% CI 88-100) and specificity was 87% (95% CI 83-92), yielding a negative likelihood ratio of 0.06 (95% CI 0-0.14) and positive likelihood ratio of 7.4 (95% CI 4.8-10). ACS was subsequently diagnosed in 10% of patients. Risk factors included 12% diabetes, 42% hypertension, 35% smokers, 29% had hyperlipidemia, and 7% known CAD. The pooled patient population was 52В В±В 2В years of age, 51% male, with low to intermediate pretest probability for ACS. Nine studies (NВ =В 1349) formed the data set. Inclusion criteria were: (1) prospective study with в‰Ґ1В month follow-up, (2) use of CTA in the ED setting, (3) use of ACC/AHA definitions for ACS and robust assessment of major adverse cardiac events, (4) в‰Ґ30 patients, and (5) study population with initial non-diagnostic ECGs and negative biomarkers. MethodsДЈ86 studies were identified on initial review of literature. To assess clinical utility of computed tomography angiography (CTA) in the diagnosis of chest pain patients presenting to emergency departments (EDs), we conducted a meta-analysis of CTA in patients with suspected acute coronary syndromes (ACSs).

Comprehensive meta analysis v2