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64-slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis
  1. Graham Mowatt (g.mowatt{at}abdn.ac.uk)
  1. University of Aberdeen, United Kingdom
    1. Jonathan A Cook (j.a.cook{at}abdn.ac.uk)
    1. University of Aberdeen, United Kingdom
      1. Graham S Hillis (g.hillis{at}abdn.ac.uk)
      1. Aberdeen Royal Infirmary, United Kingdom
        1. Shonagh Walker (shonaghwalker{at}btopenworld.com)
        1. Aberdeen Royal Infirmary, United Kingdom
          1. Cynthia Fraser (c.fraser{at}abdn.ac.uk)
          1. University of Aberdeen, United Kingdom
            1. Xueli Jia (x.jia{at}abdn.ac.uk)
            1. University of Aberdeen, United Kingdom
              1. Norman Waugh (n.r.waugh{at}abdn.ac.uk)
              1. University of Aberdeen, United Kingdom

                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 ¡Ý 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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