Systematic review of the clinical and cost-effectiveness of 64-slice or higher computed tomography angiography as an alternative to invasive coronary angiography in the investigation of coronary artery disease (CAD)

Summary

This health technology assessment found that 64-slice computed tomography (CT) is highly sensitive for patient-based detection of CAD and has high negative predictive value. This ability to rule out significant CAD means that it may have a role in the assessment of chest pain, particularly when the diagnosis remains uncertain despite clinical evaluation and simple non-invasive testing. It is unlikely to replace coronary angiography in the assessment for revascularisation of patients, particularly as angiography and angioplasty are often done on the same occasion. The avoidance of unnecessary coronary angiographies through the use of 64-slice CT also appears likely to result in overall cost savings within the diagnostic pathway. Only if both the cost of coronary angiography is relatively low and the prevalence of CAD within the presenting population is relatively high (so that most patients will go on to have coronary angiography) will the use of 64-slice CT be likely to result in a higher overall diagnostic cost per patient.

This project was commissioned by the NIHR HTA programme.

Contact 

Cynthia Fraser; c.fraser@abdn.ac.uk

Status

Completed

Publications

Mowatt G, Cummins E, Waugh N, Walker S, Cook J, Jia X, Hillis G, Fraser C. Systematic review of the clinical effectiveness and cost-effectiveness of 64-slice or higher computed tomography angiography as an alternative to invasive coronary angiography in the investigation of coronary artery disease. Health Technol Assess 2008;12(17):1-163.

Mowatt G, Cook JA, Hillis GS, Walker S, Fraser C, Jia X, Waugh N. 64-slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis.  Heart 2008;94(11):1386-93.