The diagnostic performance of coronary computed tomography angiography, an emerging noninvasive modality used as an alternative to ICA for the assessment of coronary artery disease, is generally variable across studies and clinical settings. The objective of this study is to systematically assess the diagnostic accuracy of coronary computed tomography angiography (CCTA) in comparison with invasive coronary angiography (ICA) in the detection of anatomically significant CAD. A systematic review and meta-analysis were conducted according to PRISMA guidelines. A search of PubMed, Scopus, and Web of Science for eligible studies through December 2025 was conducted. Studies were included if they reported CCTA diagnostic accuracy data with ICA as the reference standard. The risk of bias was assessed using QUADAS-2. The pooled sensitivity and specificity, along with the likelihood ratios and diagnostic odds ratio (DOR), were estimated using a Bayesian bivariate model. Summary receiver operating characteristic curves and Fagan nomograms were generated to assess overall performance and clinical utility. Twenty-seven studies encompassing 4461 patients were included in the quantitative synthesis. CCTA demonstrated high pooled sensitivity of 0.94 (95% posterior interval PI 0.892–0.969) and moderate specificity of 0.73 (95% PI 0.560–0.846). The pooled positive and negative likelihood ratios were 3.50 and 0.08, respectively, with a diagnostic odds ratio of 43.8, indicating strong overall discriminatory ability. Subgroup analyses showed higher accuracy in patients without prior coronary Intervention, while specificity was reduced in post-percutaneous coronary Intervention (PCI) or coronary artery bypass grafting (CABG) populations. A negative CCTA markedly reduced the post-test probability of CAD, supporting its value as a rule-out test. CCTA demonstrates high sensitivity and strong rule-out performance for anatomically significant CAD, particularly in appropriately selected low-to-intermediate-risk patients without prior coronary Intervention. However, its moderate specificity and reduced performance in complex post-PCI/CABG populations indicate that positive findings should be interpreted cautiously and may require confirmatory invasive or functional assessment. Not applicable.
Alqahtani et al. (Mon,) studied this question.