CT angiography compared to invasive angiography for stable coronary disease as predictors of Major Adverse Cardiovascular Events- a systematic review and meta-analysis

Background: Computational tomography coronary angiography (CTCA) is increasingly the diagnostic test of choice for investigating patients with stable anginal symptoms. Objectives: We sought to conduct a systematic review and meta-analysis comparing CTCA with invasive coronary angiography (ICA) with regards to major adverse cardiovascular events (MACE), procedural complications and rates of revascularisation. Methods: We conducted a systematic review and meta-analysis in line with the PRISMA statement. A literature search was conducted using PubMed, MEDLINE Ovid and Embase, with three studies included in meta-analysis. Statistical analysis was undertaken using Review Manager 5.3 for MacOS software and outcomes expressed as odds ratio, with 95% confidence intervals and sensitivity analysis was conducted. Results: A total of 5662 patients were included in this study level meta-analysis. There was no difference in MACE between CT and angiography [2.97% v 3.45%, fixed-effect model, OR: 0.84 (0.62–1.14), p = 0.26, I2 0%] and no difference found in rates of myocardial infarction, death or stroke. CTCA was associated with a reduced rate of revascularisation [12.6% v 18.3%, fixed-effects model, OR: 0.64 (0.55–0.75), p<0.00001, I2 =0%]. However, CTCA was not associated with a significantly lower complication rate [0.5% v 1.72%, random effects model, OR: 0.52 (0.06–4.38), p = 0.55, I2 52%]. Conclusion: CTCA is a safe strategy for investigating patients with stable angina with no associated increase in MACE but a reduction in revascularisation rates

Continuity and change in the institution of town and country planning: modelling the role of ideology

The institution of town and country planning rests upon ideas and concepts which will always be contested. Such concepts include ‘liberty’, ‘community’, ‘society’ and ‘the state’. It is a function of political ideology to seek to fix the meanings of contested concepts and thus exert control over political reality. By analysing the particular conceptual structure of the ideologies which seek to influence planning from positions of political power, the analyst can show how these ideologies are related to shifts in the conceptual and institutional structure of planning. The paper illustrates this analytical method in the context of the transition from the ideology of New Labour to the ideology of the Conservative-led Coalition government in England after 2010