Abstract 12801: Coronary Computed Tomography Angiography versus Conventional Functionally Testing in Patients with Stable Angina Pectoris - A Systematic Review and Meta-Analysis of Diagnostic Test Performance and Post-test Outcomes
Purpose: In the evaluation of patients with suspected coronary artery disease (CAD), the role of non-invasive testing plays an important role in risk stratification and selection of further treatment strategies. For this purpose, coronary computed tomography angiography (CCTA) has been proposed as an alternative. However, hitherto few studies have compared the modalities directly. We aimed by a systematic literature review and meta-analyses to evaluate the diagnostic accuracy and post-test outcomes of conventional exercise electrocardiography (XECG) and single positron emission computed tomography (SPECT) compared to CCTA in stable patients suspected of CAD.
Methods: We searched online databases (PubMed, Embase and Cochrane) for studies published between January 2002 and February 2013 examining the diagnostic accuracy [using invasive coronary angiography (ICA) as reference standard] and outcomes [downstream test utilization defined as ICA, SPECT, CCTA or XECG (DTU), coronary revascularization and acute myocardial infarction (AMI)] after CCTA (≥ 16-slice), compared to XECG and SPECT.
Results: Combined results of11 studies including 1575 patients demonstrated a higher diagnostic sensitivity of CCTA vs. XECG and SPECT, 98% (95% CI, 93-99) vs. 67% (95% CI, 54-78) (p ≤ 0.001) and 99% (95% CI, 96-100) vs. 73% (95% CI 59-83) (p = 0.001), respectively. Specificity of CCTA was 82% (95% CI, 63-93) vs. 46% (95% CI, 30-64) (p ≤ 0.001) for XECG, and 71% (95% CI, 60-80) vs. 48% (95% CI, 31-64) (p = 0.14) for SPECT. Seven non-randomized studies comprising 216.603 patients with a mean follow-up period of 20 months assessed post-test outcomes. The odds ratio (OR) of DTU for CCTA vs. XECG/SPECT testing was 1.38 (95% CI, 1.33-1.43, p ≤ 0.001), for revascularization OR=2.63 (CI=95%, 2.50-2.77, p ≤ 0.001) and for AMI OR=0.53 (95% CI, 0.39-0.72, p ≤ 0.001).
Conclusion: The diagnostic performance of CCTA was substantially higher than for XECG and SPECT, respectively. CCTA testing was associated with increased risk of DTU and coronary revascularization but a decreased risk of AMI as compared to XECG/SPECT.
- © 2013 by American Heart Association, Inc.