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The most recent version of this article was published on 1 November 2008

Heart. Published Online First: 31 July 2008. doi:10.1136/hrt.2008.145292
Copyright © 2008 BMJ Publishing Group Ltd & British Cardiovascular Society

Systematic review

64-slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis

Graham Mowatt 1*, Jonathan A Cook 1, Graham S Hillis 2, Shonagh Walker 2, Cynthia Fraser 1, Xueli Jia 1 and Norman Waugh 1

1 University of Aberdeen, United Kingdom
2 Aberdeen Royal Infirmary, United Kingdom

* To whom correspondence should be addressed. E-mail: g.mowatt{at}abdn.ac.uk.

Accepted 17 June 2008


Abstract

Objective: To assess whether 64-slice computed tomography (CT) angiography might replace some coronary angiography (CA) for diagnosis and assessment of coronary artery disease (CAD).

Methods: We searched electronic databases, conference proceedings and scanned reference lists of included studies. 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 were pooled using the hierarchical summary receiver operating characteristic model.

Results: Forty studies were included; 28 provided sufficient data for inclusion in the meta-analyses, all using a cutoff of ¡Y 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 to 100%) and negative predictive value (NPV) 100% (range 86 to 100%). In segment-based detection (n=14199) 64-slice CT pooled sensitivity was 90% (95% CrI 85 to 94%), specificity 97% (95% CrI 95 to 98%), median positive predictive value (PPV) across studies 76% (range 44 to 93%) and negative predictive value (NPV) 99% (range 95 to 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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