What question did this study set out to answer?

To assess the diagnostic accuracy of coronary computed tomography angiography (CTA) across varying clinical pretest probabilities of coronary artery disease (CAD) and evaluate performance across clinically relevant subgroups.

June 12, 2019BMJOpen Access

Diagnosis of obstructive coronary artery disease using computed tomography angiography in patients with stable chest pain depending on clinical probability and in clinically important subgroups: meta-analysis of individual patient data

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Authors

RHRobert HaaseUniversity of Bonn PSPeter SchlattmannJena University Hospital PGPascal GuéretCedars-Sinai Medical Center

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Implication

Meta-analysis reveals optimal coronary CTA accuracy at 7% to 67% pretest probability, indicating its clinical utility for stable chest pain.

Key Points

To assess the diagnostic accuracy of coronary computed tomography angiography (CTA) across varying clinical pretest probabilities of coronary artery disease (CAD) and evaluate performance across clinically relevant subgroups.
Conducted an individual patient data meta-analysis of 65 prospective diagnostic accuracy studies encompassing 5,332 patients with stable chest pain and suspected CAD who underwent both coronary CTA and invasive coronary angiography (reference standard with ≥50% stenosis threshold).
Calculated positive predictive values (PPV) and negative predictive values (NPV) across pretest probabilities using generalized linear mixed models, defining appropriate test utility via a threshold model (<15% post-test probability for no-treat, >50% for treat).
Assessed diagnostic performance across subgroups stratified by sex, age, angina pectoris type, and scanner detector row count (>64 vs ≤64 rows).
Coronary CTA demonstrated an overall sensitivity of 95.2% (95% CI 92.6% to 96.9%), specificity of 79.2% (74.9% to 82.9%), and an area under the ROC curve (AUC) of 0.897 (0.889 to 0.906), functioning optimally within a pretest probability range of 7% to 67%.
At a 7% pretest probability, CTA showed a PPV of 50.9% (95% CI 43.3% to 57.7%) and an NPV of 97.8% (96.4% to 98.7%); at a 67% pretest probability, PPV was 82.7% (78.3% to 86.2%) and NPV was 85.0% (80.2% to 88.9%).
Scanners with >64 detector rows had superior sensitivity (93.4% vs 86.5%, P=0.002) and specificity (84.4% vs 72.6%, P<0.001); overall accuracy was slightly lower in women (AUC 0.874 vs 0.907, P<0.001) and patients >75 years (AUC 0.864, P=0.018), but did not differ by angina type.

Cite This Study

Haase et al. (2019) studied this question.

synapsesocial.com/papers/6a1bdb4d4ebd09f3dfa91d42 https://doi.org/10.1136/bmj.l1945

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Implication

Meta-analysis reveals optimal coronary CTA accuracy at 7% to 67% pretest probability, indicating its clinical utility for stable chest pain.

Diagnosis of obstructive coronary artery disease using computed tomography angiography in patients with stable chest pain depending on clinical probability and in clinically important subgroups: meta-analysis of individual patient data

Discussion

Member takes

Implication

Key Points

Cite This Study

Diagnosis of obstructive coronary artery disease using computed tomography angiography in patients with stable chest pain depending on clinical probability and in clinically important subgroups: meta-analysis of individual patient data

Discussion

Member takes

Implication

Key Points

Cite This Study

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