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

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381 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