Clinical Benefits of Coronary Computed Tomography Angiography for Evaluating Low-Risk Patients With Non-ST-Elevation Acute Coronary Syndrome in the Emergency Department　― Systematic Review and Meta-Analysis ―

Abstract

Background: The utility of coronary computed tomography angiography (CCTA) in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS), particularly among low-risk individuals presenting to the emergency department (ED), remains unclear. We conducted a systematic review to assess the clinical benefits of CCTA in low-risk patients presenting to the ED with chest pain.

Methods and Results: A systematic search of MEDLINE, CENTRAL, and Web of Science was performed for randomized controlled trials (RCTs) published up to March 23, 2023, comparing CCTA performed in the ED with standard care in low-risk patients with NSTE-ACS. Low-risk status was defined as resolved symptoms at ED presentation and no troponin elevation or ischemic ECG changes. Seven RCTs were extracted from the databases. No significant differences were observed between the CCTA and standard care groups in all-cause mortality, non-fatal myocardial infarction, ED revisits, or radiation exposure. However, hospital length of stay was significantly shorter and healthcare costs were slightly lower in the CCTA group. Conversely, revascularization and invasive coronary angiography were significantly more frequent in this group.

Conclusions: In low-risk patients with NSTE-ACS, CCTA performed in the ED did not reduce adverse clinical events but was associated with shorter hospital stays and marginally reduced healthcare costs. These findings suggest that CCTA may be a useful tool that supports the safe and early discharge of selected patients.