Diagnostic performance between computed tomography angiography and high-sensitivity troponin for acute coronary syndrome in the emergency department: a systematic review and meta-analysis.

BACKGROUND

Rapid and accurate identification of patients with acute coronary syndrome (ACS) in the emergency department (ED) is no easy task. This study aimed to assess and compare the diagnostic utility of computed tomography angiography (CTA) and high-sensitivity troponin (hsTn) for patients with ACS in the ED. This meta-analysis focuses on patients presenting with acute chest pain.

METHODS

All relevant articles were retrieved from PubMed, Embase, and the Cochrane Library up to October 2025. The methodological quality of the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Pooled results were presented with 95% confidence intervals (CIs), and appropriate models were selected based on study heterogeneity. Diagnostic performance was expressed as the area under the curve (AUC). Heterogeneity of meta-analysis were evaluated through subgroup and sensitivity analysis.

RESULTS

A total of 21 studies (14 focused on CTA and 7 on hsTn) were included, involving 4,239 patients, predominantly at low-to-intermediate risk. Of these, 21% were diagnosed with ACS. The pooled sensitivity and specificity of CTA for diagnosing ACS were 0.94 (95% CI: 0.89-0.97) and 0.83 (95% CI: 0.73-0.90), respectively, with an AUC value of 0.96 (95% CI: 0.94-0.97). hsTn demonstrated pooled sensitivity and specificity of 0.84 (95% CI: 0.53-0.96) and 0.76 (95% CI: 0.55-0.89) for ACS diagnosis, with an AUC value of 0.86 (95% CI: 0.82-0.88). CTA exhibited higher diagnostic accuracy than hsTn (0.96 vs. 0.86, P<0.05).

CONCLUSIONS

In the assessment of patients presenting with acute chest pain in the ED, CTA exhibited higher diagnostic accuracy than hsTn. This indicates that CTA may be more effective in ruling out the presence of ACS in patients with low to moderate risk. However, there was heterogeneity between studies and moderate specificity, which needs to be interpreted with caution.