Outcomes of non-invasive diagnostic modalities for the detection of coronary artery disease: network meta-analysis of diagnostic randomised controlled trials

Figures

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  Fig 1. Network plots of examined diagnostic strategies across different patient groups. Network plots show comparisons across the available diagnostic strategies for each group of study populations (A and C), and consider stress echocardiography, single photon emission computed tomography-myocardial perfusion imaging, exercise electrocardiograms, or real time myocardial contrast echocardiography in the same group of diagnostic modalities of traditional functional testing (B and D). Anatomical testing pertains to coronary computed tomographic angiography. ECG=electrocardiogram; echo=echocardiography; RTMCE=real time myocardial contrast echocardiography; SPECT-MPI=single photon emission computed tomography-myocardial perfusion imaging; CCTA=coronary computed tomographic angiography; CMR=cardiovascular magnetic resonance

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  Fig 2. Pathways taken following the index diagnostic intervention across included diagnostic randomised controlled trials for patients with (A) low risk acute coronary syndrome and (B) suspected stable coronary artery disease. Numbers indicate total number of trials in which each index diagnostic strategy (arm of randomisation) was applied. The final list of diagnostic strategies in each graph refer to downstream tests performed after the index diagnostic strategy. *Information on downstream testing is missing from one trial. ICA=invasive coronary angiography; ECG=electrocardiogram; echo=echocardiography; RTMCE=real time myocardial contrast echocardiography; SPECT-MPI=single photon emission computed tomography-myocardial perfusion imaging; CCTA=coronary computed tomographic angiography; CMR=cardiovascular magnetic resonance

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  Fig 3. Νetwork meta-analysis effects of examined individual diagnostic strategies versus coronary computed tomographic angiography (anatomical testing), for study group of patients with low risk acute coronary syndrome. Forest plot considers individual diagnostic strategies, as shown in figure 1A. Index test indicates any diagnostic modality other than coronary computed tomographic angiography (anatomical testing). Network meta-analysis for the outcome of death was not feasible because of missing data and zero events. ECG=electrocardiogram; echo=echocardiography; SPECT-MPI=single photon emission computed tomography-myocardial perfusion imaging; CCTA=coronary computed tomographic angiography; CMR=cardiovascular magnetic resonance

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  Fig 4. Νetwork meta-analysis effects of examined grouped diagnostic strategies versus coronary computed tomographic angiography (anatomical testing), for study group of patients with low risk acute coronary syndrome. Forest plot considers grouping of functional tests, as shown in figure 1B. Index test indicates any diagnostic modality other than coronary computed tomographic angiography (anatomical testing). Network meta-analysis for the outcome of death was not feasible because of missing data and zero events. CCTA=coronary computed tomographic angiography; CMR=cardiovascular magnetic resonance

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  Fig 5. Νetwork meta-analysis effects of examined individual diagnostic strategies versus coronary computed tomographic angiography (anatomical testing), for study group of patients with stable coronary artery disease. Forest plot consider individual diagnostic strategies, as shown in figure 1C. Index test indicates any diagnostic modality other than coronary computed tomographic angiography (anatomical testing). Real time myocardial contrast echocardiography was not included in the network meta-analysis for outcome of downstream testing because of unavailable data. ECG=electrocardiogram; echo=echocardiography; RTMCE=real time myocardial contrast echocardiography; SPECT-MPI=single photon emission computed tomography-myocardial perfusion imaging; CCTA=coronary computed tomographic angiography; CMR=cardiovascular magnetic resonance

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  Fig 6. Νetwork meta-analysis effects of examined grouped diagnostic strategies versus coronary computed tomographic angiography (anatomical testing), for study group of patients with stable coronary artery disease. Forest plot considers grouping of functional tests, as shown in figure 1D. Index test indicates any diagnostic modality other than coronary computed tomographic angiography (anatomical testing). CCTA=coronary computed tomographic angiography; CMR=cardiovascular magnetic resonance