Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Cardiovascular Disorders
Published in: BMC Cardiovascular Disorders 1/2011

Open Access 01-12-2011 | Research article

A systematic review of the clinical effectiveness of 64-slice or higher computed tomography angiography as an alternative to invasive coronary angiography in the investigation of suspected coronary artery disease

Authors: Daniel C Paech, Adèle R Weston

Published in: BMC Cardiovascular Disorders | Issue 1/2011

Login to get access

Abstract

Background

This systematic review summarized recent evidence pertaining to the clinical effectiveness of 64-slice or higher computed tomography angiography (CTA) in patients with suspected coronary artery disease (CAD). If CTA proves to be a successful diagnostic performance measure, it could prevent the use of invasive diagnostic procedures in some patients. This would provide multiple health and cost benefits, particularly for under resourced areas where invasive coronary angiography is not always available.

Methods

A systematic method of literature searching and selection was employed with searches limited to December 2006 to March 2009. Included studies were quality assessed using National Health and Medical Research Council (NHMRC) diagnostic levels of evidence and a modified Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. Individual and pooled diagnostic performance measures were calculated using standard meta-analytic techniques at the patient, vessel and segment level. A positive result was defined as greater than or equal to 50% stenosis.

Results

Twenty-eight studies were included in the systematic review examining 3,674 patients. The primary meta-analysis at the patient-level indicated a sensitivity of 98.2% and specificity of 81.6%. The median (range) positive predictive value (PPV) was 90.5% (76%-100%) and negative predictive value (NPV) 99.0% (83%-100%). In all vessels, the pooled sensitivity was 94.9%, specificity 89.5%, and median (range) PPV 75.0% (53%-95%) and NPV 99.0% (93%-100%). At the individual artery level, overall diagnostic accuracy appeared to be slightly higher in the left main coronary artery and slightly lower in the left anterior descending and circumflex artery. In all segments, the sensitivity was 91.3%, specificity 94.0% and median (range) PPV 69.0% (44%-86%) and NPV 99.0% (98%-100%).

Conclusions

The high sensitivity indicates that CTA can effectively identify the majority of patients with significant coronary artery stenosis. The high NPV at the patient, vessel and segment level establishes CTA as an effective non-invasive alternative to invasive coronary angiography (ICA) for the exclusion of stenosis.
Appendix
Available only for authorised users
Literature
1.
American Heart Association: Heart Disease and Stroke Statistics: 2009 Update. Dallas, Texas. 2009, American Heart Association, 1-36.
2.
Togni M, Balmer F, Pfiffner D, Maier W, Zeiher A, Meier B: Percutaneous coronary interventions in Europe 1992-2001. Eur Heart J. 2004, 25: 1208-1213. 10.1016/j.ehj.2004.04.024.CrossRefPubMed
3.
Wittlinger T, Voigtlander T, Rohr M, Meyer J, Thelen M, Kreitner KF, Kalden P: Magnetic resonance imaging of coronary artery occlussions in the navigator technique. Int J Cardiovasc Imaging. 2002, 18: 203-211. 10.1023/A:1014627701695.CrossRefPubMed
4.
Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS, Ferguson TB, Fihn SD, Fraker TD, Gardin JM, O'Rourke RA, Pasternak RC, Williams SV: ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation. 2003, 107: 149-158. 10.1161/01.CIR.0000047041.66447.29.CrossRefPubMed
5.
Beers MH, Berkow R: The Merck manual of diagnosis and therapy. 1999, American College of Cardiology
6.
7.
Mowatt G, Vale L, Brazelli M, Hernandez R, Murray A, Scott N: Systematic review of the effectiveness and cost-effectiveness, and economic evaluation, of myocardial perfusion scintigraphy for the diagnosis and management of angina and myocardial infarction. Health Technol Assess. 2004, 8: 1-207.CrossRef
8.
Brodoefel H, Reimann A, Burgstahler C, Schumacher F, Herberts TM, Tsiflikas I, Schroeder S, Claussen CD, Kopp AF, Heuschmid M: Noninvasive coronary angiography using 64-slice spiral computed tomography in an unselected patient collective: Effect of heart rate, heart rate variability and coronary calcifications on image quality and diagnostic accuracy. Eur J Radiol. 2008, 66: 134-141. 10.1016/j.ejrad.2007.05.013.CrossRefPubMed
9.
10.
Mowatt G, Cummins E, Waugh N, Walker S, Cook J, Jia X, Hillis GS, Fraser C: Systematic review of the clinical effectiveness and cost-effectiveness of 64-slice or higher computed tomography angiography as an alternative to invasive coronary angiography in the investigation of coronary artery disease. Health Technol Assess. 2008, 12 (17): iii-143.CrossRef
11.
Merlin T, Weston A, Tooher R: Extending an evidence hierarchy to include topics other than treatment: revising the Australian 'levels of evidence'. BMC Med Res Methodol. 2009, 9 (34): 1-8.
12.
Meijboom WB, Meijs MFL, Schuijf JD, Cramer MJ, Mollet NR, Van Mieghem CAG, Nieman K, van Werkhoven JM, Pundziute G, Weustink AC, de Vos AM, Pugliese F, Rensing B, Jukema JW, Bax JJ, Prokop M, Doevendans PA, Hunink MGM, Krestin GP, De Feyter PJ: Diagnostic accuracy of 64-slice computed tomography coronary angiography. A prospective, multicenter, multivendor study. J Am Coll Cardiol. 2008, 52: 2135-2144. 10.1016/j.jacc.2008.08.058.CrossRefPubMed
13.
Cademartiri F, Maffei E, Notarangelo F, Ugo F, Palumbo A, Lina D, Aldrovandi A, Solinas E, Reverberi C, Menozzi A, Vignali L, Malago R, Midiri M, Mollet NR, Cervellin G, Ardissino D: 64-slice computed tomography coronary angiography: Diagnostic accuracy in the real world. Radiol Med. 2008, 113: 163-180. 10.1007/s11547-008-0241-1.CrossRefPubMed
14.
Ghostine S, Caussin C, Habis M, Habib Y, Clement C, Sigal-Cinqualbre A, Angel CY, Lancelin B, Capderou A, Paul JF: Non-invasive diagnosis of ischaemic heart failure using 64-slice computed tomography. Eur Heart J. 2008, 29: 2133-2140. 10.1093/eurheartj/ehn072.CrossRefPubMed
15.
Husmann L, Schepis T, Scheffel H, Gaemperli O, Leschka S, Valenta I, Koepfli P, Desbiolles L, Stolzmann P, Marincek B, Alkadhi H, Kaufmann PA: Comparison of Diagnostic Accuracy of 64-Slice Computed Tomography Coronary Angiography in Patients with Low, Intermediate, and High Cardiovascular Risk. Acad Radiol. 2008, 15: 452-461. 10.1016/j.acra.2007.12.008.CrossRefPubMed
16.
Leber AW, Johnson T, Becker A, von Ziegler F, Tittus J, Nikolaou K, Reiser M, Steinbeck G, Becker CR, Knez A: Diagnostic accuracy of dual-source multi-slice CT-coronary angiography in patients with an intermediate pretest likelihood for coronary artery disease. Eur Heart J. 2007, 28: 2354-2360. 10.1093/eurheartj/ehm294.CrossRefPubMed
17.
Leschka S, Scheffel H, Desbiolles L, Plass A, Gaemperli O, Stolzmann P, Genoni M, Luescher T, Marincek B, Kaufmann P, Alkadhi H: Combining dual-source computed tomography coronary angiography and calcium scoring: Added value for the assessment of coronary artery disease. Heart. 2008, 94: 1154-1161. 10.1136/hrt.2007.124800.CrossRefPubMed
18.
Leschka S, Scheffel H, Husmann L, Gamperli O, Marincek B, Kaufmann PA, Alkadhi H: Effect of decrease in heart rate variability on the diagnostic accuracy of 64-MDCT coronary angiography. AJR Am J Roentgenol. 2008, 190: 1583-1590. 10.2214/AJR.07.2000.CrossRefPubMed
19.
Rixe J, Rolf A, Conradi G, Moellmann H, Nef H, Neumann T, Steiger H, Hamm CW, Dill T: Detection of relevant coronary artery disease using dual-source computed tomography in a high probability patient series: comparison with invasive angiography. Cir J. 2009, 73: 316-322. 10.1253/circj.CJ-08-0534.CrossRef
20.
Shabestari AA, Abdi S, Akhlaghpoor S, Azadi M, Baharjoo H, Pajouh MD, Emami Z, Esfahani F, Firouzi I, Hashemian M, Kouhi M, Mozafari M, Nazeri I, Roshani M, Salevatipour B, Tavalla H, Tehrai M, Zarrabi A: Diagnostic Performance of 64-Channel Multislice Computed Tomography in Assessment of Significant Coronary Artery Disease in Symptomatic Subjects. Am J Cardiol. 2007, 99: 1656-1661. 10.1016/j.amjcard.2007.01.040.CrossRefPubMed
21.
Achenbach S, Ropers U, Kuettner A, Anders K, Pflederer T, Komatsu S, Bautz W, Daniel WG, Ropers D: Randomized Comparison of 64-Slice Single- and Dual-Source Computed Tomography Coronary Angiography for the Detection of Coronary Artery Disease. JACC Cardiovasc Imaging. 2008, 1: 177-186. 10.1016/j.jcmg.2007.11.006.CrossRefPubMed
22.
Budoff MJ, Dowe D, Jollis JG, Gitter M, Sutherland J, Halamert E, Scherer M, Bellinger R, Martin A, Benton R, Delago A, Min JK: Diagnostic Performance of 64-Multidetector Row Coronary Computed Tomographic Angiography for Evaluation of Coronary Artery Stenosis in Individuals Without Known Coronary Artery Disease. Results From the Prospective Multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) Trial. J Am Coll Cardiol. 2008, 52: 1724-1732. 10.1016/j.jacc.2008.07.031.CrossRefPubMed
23.
Cademartiri F, Maffei E, Palumbo A, Malago R, Alberghina F, Aldrovandi A, Brambilla V, Runza G, La Grutta L, Menozzi A, Vignali L, Casolo G, Midiri M, Mollet NR: Diagnostic accuracy of 64-slice computed tomography coronary angiography in patients with low-to-intermediate risk. Radiologia Medica. 2007, 112: 969-981. 10.1007/s11547-007-0198-5.CrossRefPubMed
24.
Hausleiter J, Meyer T, Hadamitzky M, Zankl M, Gerein P, Dorrler K, Kastrati A, Martinoff S, Schomig A: Non-invasive coronary computed tomographic angiography for patients with suspected coronary artery disease: The coronary angiography by computed tomography with the use of a submillimeter resolution (CACTUS) trial. Eur Heart J. 2007, 28: 3034-3041. 10.1093/eurheartj/ehm150.CrossRefPubMed
25.
Herzog C, Zwerner PL, Doll JR, Nielsen CD, Nguyen SA, Savino G, Vogl TJ, Costello P, Schoepf UJ: Significant coronary artery stenosis: Comparison on per-patient and per-vessel or per-segment basis at 64-section CT Angiography. Radiology. 2007, 244: 112-120. 10.1148/radiol.2441060332.CrossRefPubMed
26.
Meijboom WB, Mollet NR, Van Mieghem CA, Weustink AC, Pugliese F, van Pelt N, Cademartiri F, Vourvouri E, De Jaegere P, Krestin GP, De Feyter PJ: 64-Slice CT coronary angiography in patients with non-ST elevation acute coronary syndrome. Heart. 2007, 93: 1386-1392. 10.1136/hrt.2006.112771.CrossRefPubMedPubMedCentral
27.
Meijboom WB, Weustink AC, Pugliese F, Van Mieghem CAG, Mollet NR, van Pelt N, Cademartiri F, Nieman K, Vourvouri E, Regar E, Krestin GP, De Feyter PJ: Comparison of diagnostic accuracy of 64-Slice computed tomography coronary angiography in women versus men with angina pectoris. Am J Cardiol. 2007, 100: 1532-1537. 10.1016/j.amjcard.2007.06.061.CrossRefPubMed
28.
Meijboom WB, Van Mieghem CAG, Mollet NR, Pugliese F, Weustink AC, van Pelt N, Cademartiri F, Nieman K, Boersma E, De Jaegere P, Krestin GP, De Feyter PJ: 64-Slice Computed tomography coronary angiography in patients with high, intermediate, or low pretest probability of significant coronary artery disease. J Am Coll Cardiol. 2007, 50: 1469-1475. 10.1016/j.jacc.2007.07.007.CrossRefPubMed
29.
Oncel D, Oncel G, Tastan A, Tamci B: Detection of significant coronary artery stenosis with 64-section MDCT angiography. Eur J Radiol. 2007, 62: 394-405. 10.1016/j.ejrad.2007.01.009.CrossRefPubMed
30.
Piers LH, Dikkers R, Willems TP, De Smet BJGL, Oudkerk M, Zijlstra F, Tio RA: Computed tomographic angiography or conventional coronary angiography in therapeutic decision-making. Eur Heart J. 2008, 29: 2902-2907. 10.1093/eurheartj/ehn454.CrossRefPubMed
31.
Scheffel H, Alkadhi H, Leschka S, Plass A, Desbiolles L, Guber I, Krauss T, Gruenenfelder J, Genoni M, Luescher TF, Marincek B, Stolzmann P: Low-dose CT coronary angiography in the step-and-shoot mode: Diagnostic performance. Heart. 2008, 94: 1132-1137. 10.1136/hrt.2008.149971.CrossRefPubMed
32.
Schlosser T, Mohrs OK, Magedanz A, Nowak B, Voigtlander T, Barkhausen J, Schmermund A: Noninvasive coronary angiography using 64-detector-row computed tomography in patients with a low to moderate pretest probability of significant coronary artery disease. Acta radiol. 2007, 48: 300-307. 10.1080/02841850701203587.CrossRefPubMed
33.
Sheth T, Amlani S, Lou Ellins M, Mehta S, Velianou J, Cappelli G, Yang S, Natarajan M: Computed tomographic coronary angiographic assessment of high-risk coronary anatomy in patients with suspected coronary artery disease and intermediate pretest probability. Am Heart J. 2008, 155: 918-923. 10.1016/j.ahj.2007.11.035.CrossRefPubMed
34.
Weustink AC, Meijboom WB, Mollet NR, Otsuka M, Pugliese F, Van Mieghem C, Malago R, van Pelt N, Dijkshoorn ML, Cademartiri F, Krestin GP, De Feyter PJ: Reliable High-Speed Coronary Computed Tomography in Symptomatic Patients. J Am Coll Cardiol. 2007, 50: 786-794. 10.1016/j.jacc.2007.04.068.CrossRefPubMed
35.
Cademartiri F, Maffei E, Palumbo AA, Malago R, Alberghina F, Aldrovandi A, Brambilla V, Runza G, La Grutta L, Menozzi A, Vignali L, Casolo G, Midiri M, Mollet NR: Influence of intra-coronary enhancement on diagnostic accuracy with 64-slice CT coronary angiography. Eur Radiol. 2008, 18: 576-583. 10.1007/s00330-007-0773-0.CrossRefPubMed
36.
Han SC, Fang CC, Chen Y, Chen CL, Wang SP: Coronary computed tomography angiography - A promising imaging modality in diagnosing coronary artery disease. J Chin Med Assoc. 2008, 71: 241-246. 10.1016/S1726-4901(08)70114-X.CrossRefPubMed
37.
Pugliese F, Mollet NR, Hunink MGM, Cademartiri F, Nieman K, Van Domburg RT, Meijboom WB, Van Mieghem C, Weustink AC, Dijkshoorn ML, De Feyter PJ, Krestin GP: Diagnostic performance of coronary CT angiography by using different generations of multisection scanners: Single-center experience. Radiology. 2008, 246: 384-393. 10.1148/radiol.2462070113.CrossRefPubMed
38.
Yoshida K, Shimada K, Tanaka A, Jissho S, Tanaka H, Yoshiyama M, Yoshikawa J: Quantitative analysis of myocardial contrast enhancement by first-pass 64-multidetector computed tomography in patients with coronary heart disease. Circ J. 2009, 73: 116-124. 10.1253/circj.CJ-08-0283.CrossRefPubMed
39.
Abdulla J, Abildstrom SZ, Gotzsche O, Christensen E, Kober L, Torp-Pedersen C: 64-Multislice detector computed tomography coronary angiography as potential alternative to conventional coronary angiography: A systematic review and meta-analysis. Eur Heart J. 2007, 28 (24): 3042-50. 10.1093/eurheartj/ehm466.CrossRefPubMed
40.
Di Tanna GL, Berti E, Stivanello E, Cademartiri F, Achenbach S, Camerlingo MD, Grilli R: Informative value of clinical research on multislice computed tomography in the diagnosis of coronary artery disease: A systematic review. Int J Cardiol. 2008, 130 (3): 386-404. 10.1016/j.ijcard.2008.06.032.CrossRefPubMed
41.
Janne d'Othee B, Siebert U, Cury R, Jadvar H, Dunn EJ, Hoffmann U: A systematic review on diagnostic accuracy of CT-based detection of significant coronary artery disease. Eur J Radiol. 2008, 65 (3): 449-61. 10.1016/j.ejrad.2007.05.003.CrossRefPubMed
42.
Stein PD, Yaekoub AY, Matta F, Sostman HD: 64-Slice CT for Diagnosis of Coronary Artery Disease: A Systematic Review. Am J Med. 2008, 121 (8): 715-25. 10.1016/j.amjmed.2008.02.039.CrossRefPubMed
43.
Sun Z, Lin C, Davidson R, Dong C, Liao Y: Diagnostic value of 64-slice CT angiography in coronary artery disease: A systematic review. Eur J Radiol. 2008, 67 (1): 78-84. 10.1016/j.ejrad.2007.07.014.CrossRefPubMed
44.
Waugh N, Black C, Walker S, McIntyre L, Cummins E, Hillis G: The effectiveness and cost-effectiveness of computed tomography screening for coronary artery disease: Systematic review. Health Technol Assess. 2006, 10 (39): iii-38.CrossRef
Metadata
Title
A systematic review of the clinical effectiveness of 64-slice or higher computed tomography angiography as an alternative to invasive coronary angiography in the investigation of suspected coronary artery disease
Authors
Daniel C Paech
Adèle R Weston
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Cardiovascular Disorders / Issue 1/2011
Electronic ISSN: 1471-2261
DOI
https://doi.org/10.1186/1471-2261-11-32

Other articles of this Issue 1/2011

BMC Cardiovascular Disorders 1/2011 Go to the issue

Research article

Prevalence of peripheral arterial disease in subjects with moderate cardiovascular risk: Italian results from the PANDORA study Data from PANDORA (Prevalence of peripheral Arterial disease in subjects with moderate CVD risk, with No overt vascular Diseases nor Diabetes mellitus)

Research article

Incidence of Atrial Fibrillation in Patients with either Heart Failure or Acute Myocardial Infarction and Left Ventricular Dysfunction: A Cohort Study

Research article

Routine invasive management after fibrinolysis in patients with ST-elevation myocardial infarction: a systematic review of randomized clinical trials

Research article

Ultrasound screening for asymptomatic carotid stenosis in subjects with calcifications in the area of the carotid arteries on panoramic radiographs: a cross-sectional study

Research article

Assessment of left ventricular regional function in affected and carrier dogs with duchenne muscular dystrophy using speckle tracking echocardiography

Research article

Percutaneous coronary intervention in asians- are there differences in clinical outcome?

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits