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Diagnostic performance of computed tomography angiography in the detection of coronary artery in-stent restenosis: evidence from an updated meta-analysis

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Abstract

Objectives

To evaluate the performance of computed tomography angiography (CTA) ≥64 slices for detecting coronary in-stent restenosis (ISR) and determine the influence of separate characteristics on diagnostic accuracy.

Methods

We searched the PubMed, EMBASE and Cochrane databases for studies of CTA ≥64 slices in diagnosing ISR. We pooled data on bivariate modelling, and subgroup analysis was also performed.

Results

A total of 35 studies involving 4131 stents were included. The pooled positive likelihood ratio (LR+) and the negative likelihood ratio (LR–) were 14.0 and 0.10, for CTA in diagnosis-significant ISR ≥50%. LR+ and LR– were similar between CTA >64 slices versus 64 slices (both P > 0.99). LR– (0.10) was good for ruling out suspected ISR for <3-mm diameter. Time between CTA and stent implantation >6 months did not affect the ability of CTA for the high LR+ (12.3) and the LR– (0.10). Thick-strut stents ≥100 μm or bifurcation stenting demonstrated inferior accuracy, which was unfavourable for stent imaging.

Conclusions

With the high LR+ and LR– of CTA, patients with ISR may be appropriate for non-invasive angiographic follow-up. However, CTA imaging seems unsuitable for patients with characteristics unfavourable for stent imaging, such as thick-strut stents or bifurcation stenting.

Key points

• CTA may provide accurate information on characteristics of in-stent restenosis lesions.

• Using CTA, ISR patients may be appropriate for non-invasive angiographic follow-up.

• Stent diameter and the number of slices do not influence CTA.

• CTA seems unsuitable for patients with thick-strut stents or bifurcation stenting.

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Abbreviations

CHD:

Coronary heart disease

CTA:

Computed tomography angiography

ICA:

Invasive coronary angiography

ISR:

In-stent restenosis

PCI:

Percutaneous coronary intervention

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Funding

This work was supported by grants from Science Foundation of Health and Family Planning Commission of Zhejiang Province (2015KYB273)

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Author notes

  1. Tao Dai and Jiang-rong Wang are authors contributed equally

Authors and Affiliations

  1. Department of Cardiology, Yuhuangding Hospital, Qingdao University, Yantai, Shandong, 264000, China

    Tao Dai

  2. Department of Cardiology, Qianfoshan Hospital, ShanDong University, Ji’nan, Shandong, 250014, China

    Jiang-rong Wang

  3. Department of Cardiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang, Hangzhou, 310005, China

    Peng-fei Hu

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  1. Tao Dai
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Correspondence to Peng-fei Hu.

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The scientific guarantor of this publication is Tao Dai.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

The author Tao Dai has significant statistical expertise in diagnostic meta-analysis.

Informed consent

All analyses were based on previous published studies; thus, no ethical approval and patient consent are required.

Ethical approval

Institutional review board approval was not required because all analyses were based on previous published studies; thus, no ethical approval and patient consent are required.

Methodology

This is a diagnostic meta-analysis performed at one medical institution.

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Dai, T., Wang, Jr. & Hu, Pf. Diagnostic performance of computed tomography angiography in the detection of coronary artery in-stent restenosis: evidence from an updated meta-analysis. Eur Radiol 28, 1373–1382 (2018). https://doi.org/10.1007/s00330-017-5097-0

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