The diagnostic performance of multi-slice coronary computed tomographic angiography: a systematic review

Abstract

Background: The use of coronary computed tomographic angiography (CCTA) for evaluation of patients with suspected coronary artery disease (CAD) is growing rapidly, yet questions remain regarding its diagnostic accuracy and its impact on clinical decision-making and patient outcomes.

Methods: A systematic literature review was conducted to identify studies examining (a) CCTA's diagnostic accuracy; and (b) the impact of CCTA on clinical decision-making and/or patient outcomes. Diagnostic accuracy estimates were limited to patient-based analyses of occlusion; outcome studies were eligible for inclusion if they involved patients at low-to-intermediate risk of CAD. Pooled accuracy estimates were derived using bivariate random effects models; non-diagnostic CCTA results were conservatively assumed to be false positives.

Results: A total of 42 diagnostic accuracy studies and 11 patient outcome studies were identified. The pooled mean sensitivity for CCTA in primary analyses was 98% (95% CI: 96%, 99%); specificity was 85% (81%, 89%). A small number of outcome studies set primarily in the emergency department found triage of low-risk patients using CCTA produced no serious adverse outcomes and was time-saving relative to standard triage care. Outcome studies in the outpatient setting were limited to four case series that did not directly compare patient care or outcomes with those of contemporaneous patients evaluated without CCTA.

Conclusions: CCTA appears to have high diagnostic accuracy in patients with suspected CAD, but its potential impact on clinical decision-making and patient outcomes is less well-understood, particularly in non-emergent settings.

Figure 1

PRISMA flow chart showing results of literature search. CAD: Coronary artery disease; ACS: Acute coronary syndromes; ICA: Invasive coronary angiography. CCTA: Coronary computed tomographic angiography.

Figure 2

Bivariate analysis of sensitivity and specificity of 64-slice or better CCTA. CCTA: Coronary computed tomographic angiography; TP: True positive; FP: False positive; FN: False negative; TN: True negative; CI: Confidence interval; CAD: Coronary artery disease. (a): Single-source CCTA; (b): Dual-source CCTA. (1): Low-risk for CAD; (2): Intermediate risk for CAD.

Figure 3

Summary receiver operating characteristic analysis of the diagnostic accuracy of 64-slice or better CCTA. Data point size varies according to size of study sample. AUC: Area under curve; SE: Standard error; Q*: Q index.