Meta-analysis: diagnostic accuracy of coronary CT angiography with prospective ECG gating based on step-and-shoot, Flash and volume modes for detection of coronary artery disease

Abstract

Objectives: To investigate the diagnostic performance of coronary computed tomographic angiography (CCTA) with prospective electrocardiograph (ECG) gating based on step-and-shoot (SAS), Flash and volume imaging modes.

Methods: We searched the electronic databases PubMed for all published studies regarding CCTA. We used an exact binomial rendition of the bivariate mixed-effects regression model developed for synthesis of diagnostic data.

Results: A total of 21,852 segments, 4,851 vessels and 1,375 patients were identified using database searches. Patient-level pooled sensitivity was 0.99 (95 % confidence interval [CI], 0.98-1.00); specificity was 0.88 (CI, 0.85-0.91). The results showed that the sensitivity and specificity for detection of significant stenosis did not differ in the three protocols (P = 0.24). No heterogeneity was found at the patient level for sensitivity (Q = 26.23; P = 0.12; I (2) = 27.56 % [CI, 0.00-67.02 %]) and specificity (Q = 19.54; P = 0.42; I (2) = 2.78 % [CI, 0.00-66.26 %]).

Conclusions: CCTA with prospective ECG gating has similar high diagnostic value to rule out CAD in all three presented modes.

Key points: • The accuracy of CCTA with different prospective ECG gating is similar • CCTA with prospective ECG gating is effective to exclude coronary artery disease • The radiation dose of volume mode increases with higher heart rate.