The Diagnostic Performance of Multi-slice Coronary Computed Tomographic Angiography: a Systematic Review
- First Online:
- 102 Downloads
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.
A systematic literature review was conducted to identify studies examining (a) CCTA’s diagnostic accuracy; and (b) the impact of CCTA on clinical decision-making 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.
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.
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 WORDSmultislice CT coronary artery disease diagnostic value systematic review
- 1.Centers for Disease Control and Prevention. CDC. Heart Disease Facts and Statistics. Available at: http://www.cdc.gov/print.do?url=http://www.cdc.gov/heartdisease/facts.htm. Accessed October 13, 2010.
- 4.Gibbons RJ, Balady GJ, Bricker JT, et al. ACC/AHA 2002 guideline update for exercise testing: summary article. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee to Update the 1997 Exercise Testing Guidelines). J Am Coll Cardiol. 2002;40:1531–40.CrossRefPubMedGoogle Scholar
- 6.IMV Medical Research. Present practices & future directions in cardiac imaging: the cardiologist’s perspective. IMV Medical Information Division. Feb. 3, 2009.Google Scholar
- 8.Institute for Clinical and Economic Review. Coronary Computed Tomographic Angiography for Detection of Coronary Artery Disease. Available at: http://www.icer-review.org/index.php/ccta.html. Accessed October 13, 2010.
- 12.Mowatt G, Cummins E, Waugh N, et al. Systematic review of the clinical effectiveness and cost-effectiveness of 64-slice or higher computed tomography angiography as an alternative to invasive coronary angiography in the investigation of coronary artery disease. Health Technol Assess. 2008;12(17):iii-iv, ix-143.Google Scholar
- 18.Schroeder S, Achenbach S, Bengel F, et al. Cardiac computed tomography: indications, applications, limitations, and training requirements: report of a Writing Group deployed by the Working Group on Nuclear Cardiology and Cardiac CT of the European Society of Cardiology and the European Council of Nuclear Cardiology. Eur Heart J. 2008;29(4):531–56.CrossRefPubMedGoogle Scholar
- 20.Budoff MJ, Dowe D, Jollis JG, et al. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) Trial. J Am Coll Cardiol. 2008;52:1724–32.CrossRefPubMedGoogle Scholar
- 23.Achenbach S, Ropers U, Kuettner A, et al. Randomized comparison of 64-slice single- and dual-source computed tomography coronary angiography for the detection of coronary artery disease. J Am Coll Cardiol. 2008;1:177–86.Google Scholar
- 27.Ehara M, Surmely JF, Kawai M, et al. Diagnostic accuracy of 64-slice computed tomography for detecting angiographically significant coronary artery stenosis in an unselected consecutive patient population: comparison with conventional invasive angiography. Circulation. 2006;70:564–71.CrossRefGoogle Scholar
- 34.Leber AW, Knez A, von Ziegler F, et al. Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography: a comparative study with quantitative coronary angiography and intravascular ultrasound.[see comment]. J Am Coll Cardiol. 2005;46:147–54.CrossRefPubMedGoogle Scholar
- 53.Maffei E, Palumbo A, Martini C, et al. Diagnostic accuracy of 64-slice computed tomography coronary angiography in a large population of patients without revascularization: registry data and review of multicentre trials. Radiol Med. 2009. doi:10.1007/s11547-009-0492-5 (Epub ahead of print).Google Scholar
- 58.Dewey M, Zimmerman E, Deissenrieder F, et al. Noninvasive coronary angiography by 320-row computed tomography with lower radiation exposure and maintained diagnostic accuracy: comparison of results with cardiac catheterization in a head-to-head pilot investigation. Circulation. 2009;120:867–75.CrossRefPubMedGoogle Scholar