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European Radiology

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01-04-2018 | Cardiac

Diagnostic performance of computed tomography angiography in the detection of coronary artery in-stent restenosis: evidence from an updated meta-analysis

Authors: Tao Dai, Jiang-rong Wang, Peng-fei Hu

Published in: European Radiology | Issue 4/2018

Abstract

Objectives

To evaluate the performance of computed tomography angiography (CTA) ≥64 slices for detecting coronary in-stent restenosis (ISR) and determine the influence of separate characteristics on diagnostic accuracy.

Methods

We searched the PubMed, EMBASE and Cochrane databases for studies of CTA ≥64 slices in diagnosing ISR. We pooled data on bivariate modelling, and subgroup analysis was also performed.

Results

A total of 35 studies involving 4131 stents were included. The pooled positive likelihood ratio (LR⁺) and the negative likelihood ratio (LR^–) were 14.0 and 0.10, for CTA in diagnosis-significant ISR ≥50%. LR⁺ and LR^– were similar between CTA >64 slices versus 64 slices (both P > 0.99). LR^– (0.10) was good for ruling out suspected ISR for <3-mm diameter. Time between CTA and stent implantation >6 months did not affect the ability of CTA for the high LR⁺ (12.3) and the LR^– (0.10). Thick-strut stents ≥100 μm or bifurcation stenting demonstrated inferior accuracy, which was unfavourable for stent imaging.

Conclusions

With the high LR⁺ and LR^– of CTA, patients with ISR may be appropriate for non-invasive angiographic follow-up. However, CTA imaging seems unsuitable for patients with characteristics unfavourable for stent imaging, such as thick-strut stents or bifurcation stenting.

Key points

• CTA may provide accurate information on characteristics of in-stent restenosis lesions.

• Using CTA, ISR patients may be appropriate for non-invasive angiographic follow-up.

• Stent diameter and the number of slices do not influence CTA.

• CTA seems unsuitable for patients with thick-strut stents or bifurcation stenting.

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Title: Diagnostic performance of computed tomography angiography in the detection of coronary artery in-stent restenosis: evidence from an updated meta-analysis
Authors: Tao Dai
Jiang-rong Wang
Peng-fei Hu
Publication date: 01-04-2018
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 4/2018
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-017-5097-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Diagnostic performance of computed tomography angiography in the detection of coronary artery in-stent restenosis: evidence from an updated meta-analysis

Abstract

Objectives

Methods

Results

Conclusions

Key points

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key points

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