Coronary Computed Tomography Angiography in Patients With Chronic Chest Pain: Systematic Review of Evidence Base and Cost-effectiveness

Nance, John William Jr MD*,†; Bamberg, Fabian MD, MPH; Schoepf, U. Joseph MD*

doi: 10.1097/RTI.0b013e3182631c5c

The diagnostic evaluation of patients without known coronary artery disease presenting with chronic stable chest pain or angina equivalent is complex. Imaging often plays a role in diagnosis and risk stratification, and a variety of techniques are available, each with inherent and situation-specific advantages and disadvantages. Coronary computed tomography angiography (CTA) has been proposed as a fast, noninvasive, reliable test to rule out disease in this population, with potential improvements in costs and outcomes compared with alternative strategies. The relatively rapid rise in coronary CTA utilization, however, has led to strong calls from clinicians and health care policy organizations alike to provide high-level evidence supporting its use. The present article provides a review of the available evidence. Alternative diagnostic strategies and currently accepted indications for coronary CTA are discussed, followed by evaluation of the evidence on diagnostic accuracy, prognostic value, effect on outcomes and health care utilization, and safety. We end with a brief outlook on future developments.

*Heart and Vascular Center, Medical University of South Carolina, Charleston, SC

The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD

Institute for Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany

Dr Schoepf is a consultant for and receives research support from Bayer, Bracco, GE, Medrad, and Siemens. Dr Bamburg has received speaker fees from Siemens Healthcare and Bayer Healthcare. Dr Nance has no conflicts of interest to declare.

Reprints: John William Nance, Jr, MD, Johns Hopkins Hospital, 601 North Caroline Street, Room 4214, Baltimore, MD 21287 (e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.