Systematic Review of Diagnostic Performance of Coronary Computed Tomographic Angiography Conducted By Institute for Clinical and Economic Review Published in Journal of General Internal Medicine
- Article details the evidence on CCTA’s accuracy and effectiveness for evaluating patients with coronary artery disease in the ER and out-patient settings -

Boston, Mass., November 22, 2010 – The Journal of General Internal Medicine has published a comprehensive systematic review of the literature on the use of Coronary Computed Tomographic Angiography (CCTA) for patients with suspected coronary artery disease (CAD).  The systematic review by the Institute for Clinical and Economic Review (ICER), a leader in comparative effectiveness research based at the Massachusetts General Hospital’s Institute for Technology Assessment, found that the evidence suggests that CCTA has high diagnostic accuracy, as compared to invasive coronary angiography (the standard of care).  However, there is limited evidence to determine its effectiveness in supporting clinical decision-making or improving patient outcomes in the out-patient setting, while there is some evidence that CCTA is comparable to other non-invasive diagnostic techniques in ruling out CAD as the cause of chest pain when used in the emergency department.

“Given the prevalence of coronary artery disease, there is increasing interest in non-invasive screening practices to identify the condition,” said Dan Ollendorf, MPH, the lead author of the article and ICER’s Chief Review Officer.  “While the use of CCTA has increased, our review has demonstrated the need for additional evidence on the impact of CCTA on deciding treatment pathways and improving patient outcomes before determining its usefulness, especially in non-emergent clinical settings.”

CAD is the leading cause of death in the U.S. and the hallmark symptom, chest pain, leads to more than 6 million emergency department visits every year.  Evaluating chest pain and determining the extent of CAD is key to treating and managing the disease.  The standard of care is invasive coronary angiography, but comes with some risks, which is why CCTA has been gaining attention as an alternative diagnostic approach.  At the same time, primary care doctors are increasingly concerned about referring patients for unnecessary testing.  An important conclusion of ICER’s analysis is that, despite its diagnostic accuracy, the long term performance of CCTA in appropriately diagnosing and treating patients and reducing long term morbidity and mortality is unknown.

“A critical part of ICER’s mission is to provide actionable information to help guide the decisions of patients, clinicians, and insurers,” said Steven Pearson, MD, a co-author of the study and ICER’s President.  “To be actionable, information has to be trustworthy, and having our work scrutinized through the peer-review process at excellent journals such as the Journal for General Internal Medicine is a critical element in assuring the rigor and validity of our findings.”

This article was published in the Journal of General Internal Medicine (JGIM).  JGIM is the official journal of the Society of General Internal Medicine.  It promotes improved patient care, research, and education in primary care, general internal medicine, and hospital medicine.  Its articles focus on clinical medicine, epidemiology, prevention, health care delivery, curriculum development, and some non-traditional themes. JGIM offers early publication on www.SpringerLink.com to reach a broad audience, with online access to abstracts and full articles rapidly growing each year.  Learn more about JGIM at www.sgim.org/go/jgim.

About ICER
The Institute for Clinical and Economic Review (ICER), based at the Massachusetts General Hospital’s Institute for Technology Assessment (ITA) and an affiliate of Harvard Medical School, provides independent evaluation of the clinical effectiveness and comparative value of new and emerging technologies. Structured as a fully transparent organization, ICER seeks to achieve its ultimate mission of informing public policy and spurring innovation in the use of evidence to improve the value of health care for all.  For more information, please visit www.icer-review.org.

For more information, contact:
Sarah K. Emond
617-724-5497   

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