Coronary computed tomography angiography vs stress testing for stable angina evaluation: Diagnostic and prognostic superiority

Table 2 Comparative outcomes between coronary computed tomography angiography and stress testing

Ref.	Sample Size	CCTA modality	Stress test comparator	Primary outcome(s)	Hazard ratio/statistics	Follow-up duration	Key findings
Singh et al[11]	3283	CCTA as add-on to standard care	Exercise ECG	CHD death or nonfatal MI; diagnostic accuracy	HR for CHD death/MI: 10.63; ECG Sensitivity: 39%, Specificity: 91%	5 years	CCTA strongly predicted CHD events; superior diagnostic accuracy over ECG
Stillman et al[12]	1050 (CCTA: 518; SPECT: 532)	CCTA to guide therapy and revascularization	SPECT MPI	MACE (MI or cardiac death); revascularization	HR 1.03 (NS); Event rate: 1.2% (CCTA-negative) vs 3.2% (SPECT-negative)	Mean 16.2 months	CCTA better identified patients at low risk and those needing revascularization
Lubbers et al[13]	350	Tiered approach: CAC → CCTA	ECG, MPI, or Echo	Event-free survival; anginal symptoms; cost	Event-free survival: 96.7% (CCTA) vs 89.8% (Functional), P = 0.011	1.2 years	Higher event-free survival and cost-effectiveness in the CCTA group
Lubbers et al[14]	268 (CT: 130; Functional: 138)	CAC → CCTA → CT perfusion (if needed)	Mostly Exercise ECG	Angiograms (with/without revascularization); further testing	Unnecessary angiograms: 1.5% vs 7.2%, P = 0.035; Revascularization: 88% vs 50%, P = 0.017	6 months	CCTA reduced unnecessary procedures; improved selection for revascularization
Linde et al[15]	600 (CCTA: 299; Control: 301)	CCTA-guided strategy	Bicycle ECG or MPI	Composite: MI, cardiac death, UAP, revascularization, readmission	Composite events: 11% (CCTA) vs 16% (Control), HR 0.62, P = 0.04; MACE HR: 0.36	Median 18.7 months	Control

To facilitate comparison, Table 2 presents a summary of the primary outcomes and statistical metrics from the five randomized controlled trials included in this review. The table highlights the diagnostic strategies, event rates, hazard ratios, and follow-up durations. Coronary computed tomography angiography consistently showed either comparable or superior performance in predicting major adverse cardiovascular events, reducing unnecessary invasive angiography, and improving clinical outcomes compared to various stress testing methods. CHD: Coronary heart disease; CCTA: Coronary computed tomography angiography; ECG: Exercise electrocardiography; MPI: Myocardial perfusion imaging; MI: Myocardial infarction; CT: Computed tomography; MACE: Major adverse cardiac events.