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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Competing interests: None.
Funding: This paper was developed from a Health Technology Assessment of the clinical and cost-effectiveness of 64-slice or higher computed tomography angiography as an alternative to invasive coronary angiography in the investigation of coronary artery disease, which was funded by the UK National Institute for Health Research Health Technology Assessment programme (project number 06/15/01). The Health Services Research Unit is core funded by the Chief Scientist Office of the Scottish Government Health Directorates.
The authors’ work was independent of the funding source. The views expressed in this report are those of the authors and not necessarily those of the funders
▸ Additional tables are published online only at http://heart.bmj.com/content/vol94/issue11
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