Comparison of Usefulness of Exercise Testing Versus Coronary Computed Tomographic Angiography for Evaluation of Patients Suspected of Having Coronary Artery Disease

Øvrehus, Kristian Altern; Jensen, Jesper K.; Mickley, Hans; Munkholm, Henrik; Bøttcher, Morten; Bøtker, Hans Erik; Nørgaard, Bjarne Linde

doi:10.1016/j.amjcard.2009.11.006

Cited by 23 publications

(18 citation statements)

References 23 publications

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“…Thus, only seven articles were appropriate for the meta-analysis (All articles could be found in PubMed or Embase) (8-14). One study was retrospective (10) and six studies were prospective (8,9,(11)(12)(13)(14). Table 1 showed the general characteristics of the seven studies.…”

Section: Literature Evaluation and Study Characteristicsmentioning

confidence: 99%

“…Two studies did not provide the raw data. Thus, only seven articles were appropriate for the meta-analysis (All articles could be found in PubMed or Embase) (8)(9)(10)(11)(12)(13)(14). One study was retrospective (10) and six studies were prospective (8,9,(11)(12)(13)(14).…”

Section: Literature Evaluation and Study Characteristicsmentioning

confidence: 99%

“…To date, several studies have compared the effectiveness of CCTA with that of ExECG for the diagnosis of CAD (8)(9)(10)(11)(12)(13)(14). But there was controversy about the specificity of two arms (12,13).…”

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confidence: 99%

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Diagnostic performance of coronary computed tomography angiography versus exercise electrocardiography for coronary artery disease: a systematic review and meta-analysis

Yin¹,

Wang²,

Zheng³

et al. 2016

J. Thorac. Dis.

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Background: Both coronary computed tomography angiography (CCTA) and exercise electrocardiography (ExECG) are non-invasive testing methods for the evaluation of coronary artery disease (CAD). However, there was controversy on the diagnostic performance of these methods due to the limited data in each single study. Therefore, we performed a meta-analysis to address these issues. Methods: We searched PubMed and Embase databases up to May 22, 2015. Two authors identified eligible studies, extracted data and accessed quality. Pooled estimation of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), summary receiver-operating characteristic curve (SROC) and the area under curve (AUC) of CCTA and ExECG for the diagnosis of CAD were calculated using Stata, Meta-Disc and Review Manager statistical software. and 0.7727±0.0638, respectively. There is no heterogeneity caused by threshold effect in CCTA or ExECG analysis. The Deeks' test showed no potential publication bias (P=0.17).Conclusions: CCTA has better diagnostic performance than ExECG in the evaluation of CAD, which can provide a better solution for the clinical problem of the diagnosis for CAD. J Thorac Dis 2016;8(7):1688-1696 jtd.amegroups.com standard for assessing anatomical stenosis severity, a variety of non-invasive testing methods have been advocated recently to provide an anatomic and/or functional evaluation of coronary artery. Available methods include exercise/stress electrocardiography (ExECG), single proton emission computed tomography (SPECT), myocardial perfusion imaging (MPI), coronary computed tomography angiography (CCTA) and coronary computed tomography with fractional flow reserve (FFRCT). Despite these facts, assessment of the presence of CAD remains challenging.Among these diagnostic methods, ExECG is a wellestablished and inexpensive procedure to evaluate intermediate risk patients with angina pectoris (2). However, ExECG has relatively limited diagnostic performance in patients with silent CAD (3). As a new non-invasive alternative test, CCTA has high diagnostic performance to rule out CAD (4,5). Moreover, CCTA can be used in patients with equivocal stress test or unable to exercise stress test (6). But this method also suffers a number of limitations, such as a progressive loss of sensitivity and specificity as the pretest probability of disease decreases (7).To date, several studies have compared the effectiveness of CCTA with that of ExECG for the diagnosis of CAD (8)(9)(10)(11)(12)(13)(14). But there was controversy about the specificity of two arms (12,13). Additionally, a major limitation of these investigations was their reliance, by necessity, on observational studies due to the limited data in each single study. Therefore, we performed a meta-analysis to compare the diagnostic performance of CCTA and ExECG for CAD based on a larger data, which indicates a more specific comparison about the value of anatomic and functional evaluation in clinical decisions. Methods ...

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Section: Literature Evaluation and Study Characteristicsmentioning

confidence: 99%

Section: Literature Evaluation and Study Characteristicsmentioning

confidence: 99%

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Diagnostic performance of coronary computed tomography angiography versus exercise electrocardiography for coronary artery disease: a systematic review and meta-analysis

Yin¹,

Wang²,

Zheng³

et al. 2016

J. Thorac. Dis.

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“…In three previous studies of patients suspected of angina and with intermediate to high pretest risk of CAD, the diagnostic performance of CTA in detecting significant CAD was consistently higher as compared to Ex-test with sensitivities and specificities of 91-100% and 80-87% for CTA versus 45-78% and 31-67% for Ex-test [12,16,17]. This study of symptomatic patients at low-intermediate pretest probability of CAD add to previous findings by showing that the inferior diagnostic performance of Ex-test relative to CTA is associated with a 50% higher rate in DTU.…”

Section: Discussionmentioning

confidence: 82%

“…Coronary multi-slice computed tomographic angiography Contrast enhanced 64-slice Dual Source CT was performed (Siemens Definition, Siemens Medical Solution, Forcheim, Germany) using a scan technique as previously reported [12].…”

Section: Patients and Data Collectionmentioning

confidence: 99%

Frontline diagnostic evaluation of patients suspected of angina by coronary computed tomography reduces downstream resource utilization when compared to conventional ischemia testing

Nielsen

Markenvard

Jensen

et al. 2010

Int J Cardiovasc Imaging

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It has been proposed that the increasing use of coronary computed tomographic angiography (CTA) may introduce additional unnecessary diagnostic procedures. However, no previous study has assessed the impact on downstream test utilization of conventional diagnostic testing relative to CTA in patients suspected of angina. The purpose of this study was to investigate the consequences of frontline exercise-stress testing (Ex-test) versus CTA on downstream test utilization in clinical practice. In two collaborating departments using either Ex-test (n = 247) or CTA (n = 251) as the frontline diagnostic test in patients suspected of angina, comparable cohorts of consecutive patients were retrospectively identified (Jan. 2007-Feb. 2008). Downstream test utilization (invasive coronary angiography, ICA; myocardial perfusion scintigraphy, and CTA) during 12 months after the index diagnostic test was recorded. Mean age was 56 years (51% men), and 96% of the total study cohort were at low-intermediate pretest risk of significant coronary disease. Overall, downstream test utilization was more frequent in the Ex-test group than in the CTA group, 32% versus 21% (P = 0.003). Subsequent myocardial scintigraphy was more frequent used (9% versus 4%, P = 0.03), whereas ICA tended to be more frequent applied in the Ex-test versus CTA group (23% vs. 18%, P = 0.15). A frontline diagnostic use in symptomatic patients of Ex-test in comparison to CTA leads to more downstream diagnostic test utilization. Future prospective trials are needed in order to define the most cost-effective diagnostic use of CTA relative to conventional ischemia testing.

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Current and evolving stent evaluation by coronary computed tomographic angiography

Hecht¹,

Gade²

2011

Cathet Cardio Intervent

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Comparison of Usefulness of Exercise Testing Versus Coronary Computed Tomographic Angiography for Evaluation of Patients Suspected of Having Coronary Artery Disease

Cited by 23 publications

References 23 publications

Diagnostic performance of coronary computed tomography angiography versus exercise electrocardiography for coronary artery disease: a systematic review and meta-analysis

Diagnostic performance of coronary computed tomography angiography versus exercise electrocardiography for coronary artery disease: a systematic review and meta-analysis

Frontline diagnostic evaluation of patients suspected of angina by coronary computed tomography reduces downstream resource utilization when compared to conventional ischemia testing

Current and evolving stent evaluation by coronary computed tomographic angiography

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