Influence of coronary artery disease prevalence on predictive values of coronary CT angiography: a meta-regression analysis
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To evaluate the impact of coronary artery disease (CAD) prevalence on the predictive values of coronary CT angiography.
We performed a meta-regression based on a generalised linear mixed model using the binomial distribution and a logit link to analyse the influence of the prevalence of CAD in published studies on the per-patient negative and positive predictive values of CT in comparison to conventional coronary angiography as the reference standard. A prevalence range in which the negative predictive value was higher than 90%, while at the same time the positive predictive value was higher than 70% was considered appropriate.
The summary negative and positive predictive values of coronary CT angiography were 93.7% (95% confidence interval [CI] 92.8–94.5%) and 87.5% (95% CI, 86.5–88.5%), respectively. With 95% confidence, negative and positive predictive values higher than 90% and 70% were available with CT for a CAD prevalence of 18–63%. CT systems with >16 detector rows met these requirements for the positive (P < 0.01) and negative (P < 0.05) predictive values in a significantly broader range than systems with ≤16 detector rows.
It is reasonable to perform coronary CT angiography as a rule-out test in patients with a low-to-intermediate likelihood of disease.
KeywordsCoronary disease Computed tomography Generalised linear mixed models Meta-regression Prevalence
Potential conflicts of interest: Dr. Schlattmann and Dr. Dewey have received research funding for meta-analyses through a joint program from the German Science Foundation (DFG) and the German Federal Ministry of Education and Research (BMBF).
Dr. Schlattmann is also supported by another grant of the DFG (Schl 3–1) and has received lecture fees from Bayer-Schering.
Dr. Dewey has received grant support from the German Heart Foundation/German Foundation of Heart Research, GE Healthcare Biosciences, Bracco, Toshiba Medical Systems, and Guerbet and lecture fees from Toshiba Medical Systems, Guerbet, Cardiac MR Academy Berlin, and Bayer-Schering.
Dr. Dewey is consultant to Guerbet and one of the principal investigators of multicenter studies on MSCT coronary angiography sponsored by Toshiba Medical Systems. He is also the author of “Cardiac CT” (2011) and “Coronary CT Angiography” (2008) published by Springer and is offering hands-on courses on cardiac CT at Charité (www.ct-kurs.de).
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