64-slice computed tomography angiography in the diagnosis and assessment of coronary artery disease

systematic review and meta-analysis

Graham Mowatt, Jonathan Alistair Cook, Graham Scott Hillis, Shonagh Mary Walker, Cynthia Mary Fraser, Xueli Jia, Norman Robert Waugh

Research output: Contribution to journalArticle

370 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)1386-1393
Number of pages8
JournalHeart
Volume94
Issue number11
Early online date31 Jul 2008
DOIs
Publication statusPublished - Nov 2008

Keywords

  • acute chest-pain
  • noninvasive detection
  • angina-pectoris
  • accuracy
  • CT
  • 16-slice
  • surgery
  • technology
  • restenosis
  • experience

Cite this

Mowatt, G., Cook, J. A., Hillis, G. S., Walker, S. M., Fraser, C. M., Jia, X., & Waugh, N. R. (2008). 64-slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis. Heart, 94(11), 1386-1393. https://doi.org/10.1136/hrt.2008.145292

64-slice computed tomography angiography in the diagnosis and assessment of coronary artery disease : systematic review and meta-analysis. / Mowatt, Graham; Cook, Jonathan Alistair; Hillis, Graham Scott; Walker, Shonagh Mary; Fraser, Cynthia Mary; Jia, Xueli; Waugh, Norman Robert.

In: Heart, Vol. 94, No. 11, 11.2008, p. 1386-1393.

Research output: Contribution to journalArticle

Mowatt, G, Cook, JA, Hillis, GS, Walker, SM, Fraser, CM, Jia, X & Waugh, NR 2008, '64-slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis', Heart, vol. 94, no. 11, pp. 1386-1393. https://doi.org/10.1136/hrt.2008.145292
Mowatt, Graham ; Cook, Jonathan Alistair ; Hillis, Graham Scott ; Walker, Shonagh Mary ; Fraser, Cynthia Mary ; Jia, Xueli ; Waugh, Norman Robert. / 64-slice computed tomography angiography in the diagnosis and assessment of coronary artery disease : systematic review and meta-analysis. In: Heart. 2008 ; Vol. 94, No. 11. pp. 1386-1393.
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abstract = "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.",
keywords = "acute chest-pain, noninvasive detection, angina-pectoris, accuracy, CT, 16-slice, surgery, technology, restenosis, experience",
author = "Graham Mowatt and Cook, {Jonathan Alistair} and Hillis, {Graham Scott} and Walker, {Shonagh Mary} and Fraser, {Cynthia Mary} and Xueli Jia and Waugh, {Norman Robert}",
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AU - Hillis, Graham Scott

AU - Walker, Shonagh Mary

AU - Fraser, Cynthia Mary

AU - Jia, Xueli

AU - Waugh, Norman Robert

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N2 - 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.

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KW - angina-pectoris

KW - accuracy

KW - CT

KW - 16-slice

KW - surgery

KW - technology

KW - restenosis

KW - experience

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JO - Heart

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SN - 1355-6037

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