The Diagnostic Performance of Multi-slice Coronary Computed Tomographic Angiography: a Systematic Review

Abstract

BACKGROUND:The use of coronary computed tomographic angiography (CCTA) for evaluation of patients with suspected coronary artery disease (CAD) is growing rapidly, yet questions remain regarding its diagnostic accuracy and its impact on clinical decision-making and patient outcomes. METHODS: A systematic literature review was conducted to identify studies examining (a) CCTA's diagnostic accuracy; and (b) the impact of CCTA on clinical decisionmaking and/or patient outcomes. Diagnostic accuracy estimates were limited to patient-based analyses of occlusion; outcome studies were eligible for inclusion if they involved patients at low-to-intermediate risk of CAD. Pooled accuracy estimates were derived using bivariate random effects models; non-diagnostic CCTA results were conservatively assumed to be false positives. RESULTS: A total of 42 diagnostic accuracy studies and 11 patient outcome studies were identified. The pooled mean sensitivity for CCTA in primary analyses was 98% (95% CI: 96%, 99%); specificity was 85% (81%, 89%). A small number of outcome studies set primarily in the emergency department found triage of low-risk patients using CCTA produced no serious adverse outcomes and was time-saving relative to standard triage care. Outcome studies in the outpatient setting were limited to four case series that did not directly compare patient care or outcomes with those of contemporaneous patients evaluated without CCTA. CONCLUSIONS: CCTA appears to have high diagnostic accuracy in patients with suspected CAD, but its potential impact on clinical decision-making and patient outcomes is less well-understood, particularly in non-emergent settings.KEY WORDS: multislice CT; coronary artery disease; diagnostic value; systematic review.

Overview with Meta-analysis of Systematic Reviews of the Diagnostic and Prognostic Value of Coronary Computed Tomography Angiography in the Emergency Department

“…The literature search generated a total of 4 SR that evaluated the diagnostic and prognostic value of CCTA ≥ 64 channels in the ED, [25][26][27][28] containing 91 primary studies. From these, 13 articles meeting the inclusion criteria were included in the qualitative analysis.…”

Downstream Testing and Subsequent Procedures After Coronary Computed Tomographic Angiography Following Coronary Stenting in Patients ≥65 Years of Age

“…In patients without known CAD, the specificity of 64-slice CCTA relative to invasive angiography is estimated at 85%. 8 …”

Toward Evidence-based Decisions in Diagnostic Radiology

“…Studies that attempted to compare the impact of CCTA with that of other noninvasive diagnostic strategies on patient outcomes were conducted in the ED only; these included a randomized controlled trial comparing CCTA with serial enzyme and nuclear stress testing (21). Although findings were mixed on whether CCTA would reduce the numbers of invasive angiographies required for a given population, CCTA’s high negative predictive value allowed faster ED discharge compared with standard triage care, without any major increase in adverse effects or the rate of major cardiovascular events (22). …”