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The Diagnostic Performance of Multi-slice Coronary Computed Tomographic Angiography: a Systematic Review

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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.

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Contributors

The authors wish to acknowledge the efforts of the advisory committee involved in this evaluation for their assistance in defining the review scope as well as reviewing and commenting on draft findings.

Funding

The systematic review was funded through pooled resources from non-profit foundation grants and unrestricted research grants from multiple sources, including health plans and life science companies. None of these companies are manufacturers of CT machines. In addition, we received a contract from the Washington state Health Technology Assessment Program for part of the work involved in this project.

Prior Presentations

This work has not been published in any peer-review journal previously, nor has it been presented at any conference.

Conflicts of Interest

Ms. Kuba was employed by the Institute for Clinical and Economic Review at the time these analyses were conducted. None of the remaining authors reported conflicts of interest.

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Correspondence to Daniel A. Ollendorf MPH, ARM.

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Ollendorf, D.A., Kuba, M. & Pearson, S.D. The Diagnostic Performance of Multi-slice Coronary Computed Tomographic Angiography: a Systematic Review. J GEN INTERN MED 26, 307–316 (2011). https://doi.org/10.1007/s11606-010-1556-x

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