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Emergency care
CT coronary angiography does not reduce mortality or myocardial infarction in low-risk patients with acute chest pain
  1. Philip D Adamson1,2,
  2. Martin P Than3
  1. 1 BHF Centre for Cardiovascular Research, University of Edinburgh, Edinburgh, UK
  2. 2 Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
  3. 3 Emergency Department, Christchurch Hospital, Christchurch, New Zealand
  1. Correspondence to Dr Philip D Adamson, BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, UK; philip.adamson{at}

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Commentary on: Gongora CA, Bavishi C, Uretsky S, et al. Acute chest pain evaluation using coronary computed tomography angiography compared with standard of care: a meta-analysis of randomised clinical trials. Heart 2018;104:215–21.


In the assessment of low-risk patients with suspected acute coronary syndrome, the routine use of non-invasive testing has been recommend by international clinical guidelines. However, limited evidence from randomised controlled trials (RCTs) exists to support such recommendations. Although a number of trials have tested the safety and efficacy of CT coronary angiography (CTCA) in this setting, most were underpowered to demonstrate benefits with regards to hard clinical endpoints.


The authors undertook a meta-analysis of RCTs published prior to March 2017 comparing CTCA with standard care in the assessment of patients with acute chest pain.1 Standard care varied across the trials but always incorporated non-invasive functional testing—that is, exercise ECG, stress echocardiography or myocardial perfusion …

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  • Contributors PDA drafted the manuscript. MPT contributed important revisions to the draft manuscript.

  • Competing interests MPT reports grants and personal fees from Abbott and Alere, grants from Beckman and personal fees from Roche.

  • Patient consent Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.