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.
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.
Authors: Raymond J Gibbons; Gary J Balady; J Timothy Bricker; Bernard R Chaitman; Gerald F Fletcher; Victor F Froelicher; Daniel B Mark; Ben D McCallister; Aryan N Mooss; Michael G O'Reilly; William L Winters; Raymond J Gibbons; Elliott M Antman; Joseph S Alpert; David P Faxon; Valentin Fuster; Gabriel Gregoratos; Loren F Hiratzka; Alice K Jacobs; Richard O Russell; Sidney C Smith Journal: J Am Coll Cardiol Date: 2002-10-16 Impact factor: 24.094
Authors: Stephen Schroeder; Stephan Achenbach; Frank Bengel; Christof Burgstahler; Filippo Cademartiri; Pim de Feyter; Richard George; Philipp Kaufmann; Andreas F Kopp; Juhani Knuuti; Dieter Ropers; Joanne Schuijf; Laurens F Tops; Jeroen J Bax Journal: Eur Heart J Date: 2007-12-15 Impact factor: 29.983
Authors: F Cademartiri; E Maffei; F Notarangelo; F Ugo; A Palumbo; D Lina; A Aldrovandi; E Solinas; C Reverberi; A Menozzi; L Vignali; R Malagò; M Midiri; N R Mollet; G Cervellin; D Ardissino Journal: Radiol Med Date: 2008-04-02 Impact factor: 3.469
Authors: Lars Husmann; Tiziano Schepis; Hans Scheffel; Oliver Gaemperli; Sebastian Leschka; Ines Valenta; Pascal Koepfli; Lotus Desbiolles; Paul Stolzmann; Borut Marincek; Hatem Alkadhi; Philipp A Kaufmann Journal: Acad Radiol Date: 2008-04 Impact factor: 3.173
Authors: Matthew J Budoff; David Dowe; James G Jollis; Michael Gitter; John Sutherland; Edward Halamert; Markus Scherer; Raye Bellinger; Arthur Martin; Robert Benton; Augustin Delago; James K Min Journal: J Am Coll Cardiol Date: 2008-11-18 Impact factor: 24.094
Authors: Penny Whiting; Anne W S Rutjes; Johannes B Reitsma; Patrick M M Bossuyt; Jos Kleijnen Journal: BMC Med Res Methodol Date: 2003-11-10 Impact factor: 4.615
Authors: Dennis T L Wong; Siang Y Soh; Brian S H Ko; James D Cameron; Marcus Crossett; Arthur Nasis; John Troupis; Ian T Meredith; Sujith K Seneviratne Journal: Cardiovasc Diagn Ther Date: 2014-08
Authors: Daniel Mudrick; Lisa A Kaltenbach; Bimal Shah; Barbara Lytle; Frederick A Masoudi; Daniel B Mark; Jerome J Federspiel; Patricia A Cowper; Cynthia Green; Pamela S Douglas Journal: Am J Cardiol Date: 2012-05-30 Impact factor: 2.778
Authors: G B John Mancini; Jonathan Leipsic; Matthew J Budoff; Cameron J Hague; James K Min; Susanna R Stevens; Harmony R Reynolds; Sean M O'Brien; Leslee J Shaw; Cholenahally N Manjunath; Kreton Mavromatis; Marcin Demkow; Jose Luis Lopez-Sendon; Alexander M Chernavskiy; Gilbert Gosselin; Herwig Schuchlenz; Gerard P Devlin; Anoop Chauhan; Sripal Bangalore; Judith S Hochman; David J Maron Journal: JACC Cardiovasc Imaging Date: 2021-01-13