64-Slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis.
Mowatt G., Cook JA., Hillis GS., Walker S., Fraser C., Jia X., Waugh N.
CONTEXT: Coronary artery disease (CAD) is a major cause of mortality and ill health. OBJECTIVE: To assess whether 64-slice CT angiography might replace some coronary angiography (CA) for diagnosis and assessment of CAD. DATA SOURCES: Electronic databases, conference proceedings and reference lists of included studies. STUDY SELECTION: Eligible studies compared 64-slice CT with a reference standard of CA in adults with suspected/known CAD, reporting sensitivity and specificity or true and false positives and negatives. DATA EXTRACTION: Two reviewers independently extracted data from included studies. RESULTS: Forty studies were included; 28 provided sufficient data for inclusion in the meta-analyses, all using a cut off point of >/=50% stenosis to define significant CAD. In patient-based detection (n = 1286) 64-slice CT pooled sensitivity was 99% (95% credible interval (CrI) 97% to 99%), specificity 89% (95% CrI 83% to 94%), median positive predictive value (PPV) across studies 93% (range 64-100%) and negative predictive value (NPV) 100% (range 86-100%). In segment-based detection (n = 14 199) 64-slice CT pooled sensitivity was 90% (95% CrI 85% to 94%), specificity 97% (95% CrI 95% to 98%), median PPV across studies 76% (range 44-93%) and NPV 99% (range 95-100%). CONCLUSIONS: 64-Slice CT is highly sensitive for patient-based detection of CAD and has high NPV. An ability to rule out significant CAD means that it may have a role in the assessment of chest pain, particularly when the diagnosis remains uncertain despite clinical evaluation and simple non-invasive testing.