The diagnostic accuracy and outcomes after coronary computed tomography angiography vs. conventional functional testing in patients with stable angina pectoris: a systematic review and meta-analysis

Nielsen LH, Ortner N, Norgaard BL, Achenbach S, Leipsic J, Abdulla J (2014)

Publication Type: Journal article

Publication year: 2014

Journal

European Heart Journal - Cardiovascular Imaging Oxford University Press

Publisher: Oxford University Press

Book Volume: 15

Pages Range: 961-71

Journal Issue: 9

DOI: 10.1093/ehjci/jeu027

Abstract

To systematically review and perform a meta-analysis of the diagnostic accuracy and post-test outcomes of conventional exercise electrocardiography (XECG) and single-photon emission computed tomography (SPECT) compared with coronary computed tomography angiography (coronary CTA) in patients suspected of stable coronary artery disease (CAD).We systematically searched for studies published from January 2002 to February 2013 examining the diagnostic accuracy (defined as at least >=50% luminal obstruction on invasive coronary angiography) and outcomes of coronary CTA (>=16 slice) in comparison with XECG and SPECT. The search revealed 11 eligible studies (N = 1575) comparing the diagnostic accuracy and 7 studies (N = 216.603) the outcomes of coronary CTA vs. XECG or/and SPECT. The per-patient sensitivity [95% confidence interval (95% CI)] to identify significant CAD was 98% (93-99%) for coronary CTA vs. 67% (54-78%) (P < 0.001) for XECG and 99% (96-100%) vs. 73% (59-83%) (P = 0.001) for SPECT. The specificity (95% CI) of coronary CTA was 82% (63-93%) vs. 46% (30-64%) (P < 0.001) for XECG and 71% (60-80%) vs. 48% (31-64%) (P = 0.14) for SPECT. The odds ratio (OR) of downstream test utilization (DTU) for coronary CTA vs. XECG/SPECT was 1.38 (1.33-1.43, P < 0.001), for revascularization 2.63 (2.50-2.77, P < 0.001), for non-fatal myocardial infarction 0.53 (0.39-0.72, P < 0.001), and for all-cause mortality 1.01 (0.87-1.18, P = 0.87).The up-front diagnostic performance of coronary CTA is higher than of XECG and SPECT. When compared with XECG/SPECT testing, coronary CTA testing is associated with increased DTU and coronary revascularization.

Authors with CRIS profile

Stephan Achenbach Department of Medicine 2 – Cardiology and Angiology

Involved external institutions

Vejle Sygehus DK Denmark (DK) Rigshospitalet DK Denmark (DK) Aarhus University Hospital / Aarhus Universitetshospital DK Denmark (DK) St. Paul's Hospital CA Canada (CA)

How to cite

APA:

Nielsen, L.H., Ortner, N., Norgaard, B.L., Achenbach, S., Leipsic, J., & Abdulla, J. (2014). The diagnostic accuracy and outcomes after coronary computed tomography angiography vs. conventional functional testing in patients with stable angina pectoris: a systematic review and meta-analysis. European Heart Journal - Cardiovascular Imaging, 15(9), 961-71. https://doi.org/10.1093/ehjci/jeu027

MLA:

Nielsen, Lene H., et al. "The diagnostic accuracy and outcomes after coronary computed tomography angiography vs. conventional functional testing in patients with stable angina pectoris: a systematic review and meta-analysis." European Heart Journal - Cardiovascular Imaging 15.9 (2014): 961-71.

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