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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
- Source :
- BMJ (Clinical research ed.), Vol. 365, no. 8209, p. l1945 [1-15] (2019), Haase, R, Schlattmann, P, Gueret, P, Andreini, D, Pontone, G, Alkadhi, H, Hausleiter, J, Garcia, M J, Leschka, S, Meijboom, W B, Zimmermann, E, Gerber, B, Schoepf, U J, Shabestari, A A, Nørgaard, B L, Meijs, M F L, Sato, A, Ovrehus, K A, Diederichsen, A C P, Jenkins, S M M, Knuuti, J, Hamdan, A, Halvorsen, B A, Mendoza-Rodriguez, V, Rochitte, C E, Rixe, J, Wan, Y L, Langer, C, Bettencourt, N, Martuscelli, E, Ghostine, S, Buechel, R R, Nikolaou, K, Mickley, H, Yang, L, Zhang, Z, Chen, M Y, Halon, D A, Rief, M, Sun, K, Hirt-Moch, B, Niinuma, H, Marcus, R P, Muraglia, S, Jakamy, R, Chow, B J, Kaufmann, P A, Tardif, J-C, Nomura, C, Kofoed, K F & COME-CCT Consortium 2019, ' 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 ', B M J, vol. 365, l1945 . https://doi.org/10.1136/bmj.l1945, Haase, R, Schlattmann, P, Gueret, P, Andreini, D, Pontone, G, Alkadhi, H, Hausleiter, J, Garcia, M J, Leschka, S, Meijboom, W B, Zimmermann, E, Gerber, B, Schoepf, U J, Shabestari, A A, Nørgaard, B L, Meijs, M F L, Sato, A, Ovrehus, K A, Diederichsen, A C P, Jenkins, S M M, Knuuti, J, Hamdan, A, Halvorsen, B A, Mendoza-Rodriguez, V, Rochitte, C E, Rixe, J, Wan, Y L, Langer, C, Bettencourt, N, Martuscelli, E, Ghostine, S, Buechel, R R, Nikolaou, K, Mickley, H, Yang, L, Zhang, Z, Chen, M Y, Halon, D A, Rief, M, Sun, K, Hirt-Moch, B, Niinuma, H, Marcus, R P, Muraglia, S, Jakamy, R, Chow, B J, Kaufmann, P A, Tardif, J-C, Nomura, C, Kofoed, K F & COME-CCT Consortium 2019, ' 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 ', B M J, vol. 365, el1945 . https://doi.org/10.1136/bmj.l1945, Haase, R, Schlattmann, P, Gueret, P, Andreini, D, Pontone, G, Alkadhi, H, Hausleiter, J, Garcia, M J, Leschka, S, Meijboom, W B, Zimmermann, E, Gerber, B, Schoepf, U J, Shabestari, A A, Nørgaard, B L, Meijs, M F L, Sato, A, Ovrehus, K A, Diederichsen, A C P, Jenkins, S M M, Knuuti, J, Hamdan, A, Halvorsen, B A, Mendoza-Rodriguez, V, Rochitte, C E, Rixe, J, Wan, Y L, Langer, C, Bettencourt, N, Martuscelli, E, Ghostine, S, Buechel, R R, Nikolaou, K, Mickley, H, Yang, L, Zhang, Z, Chen, M Y, Halon, D A, Rief, M, Sun, K, Hirt-Moch, B, Niinuma, H, Marcus, R P, Muraglia, S, Jakamy, R, Chow, B J, Kaufmann, P A, Tardif, J C, Nomura, C, Kofoed, K F, Laissy, J P, Arbab-Zadeh, A, Kitagawa, K, Laham, R, Jinzaki, M, Hoe, J, Rybicki, F J, Scholte, A, Paul, N, Tan, S Y, Yoshioka, K, Röhle, R, Schuetz, G M, Schueler, S, Coenen, M H, Wieske, V, Achenbach, S, Budoff, M J, Laule, M, Newby, D E & Dewey, M 2019, ' 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 ', The BMJ, vol. 365, el1945 . https://doi.org/10.1136/bmj.l1945, British Medical Journal, 365. BMJ PUBLISHING GROUP, The BMJ, 2019, ' 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 ', British Medical Journal (BMJ), pp. l1945 . https://doi.org/10.1136/bmj.l1945, BMJ-British medical journal, 365:l1945. BMJ Publishing Group
- Publication Year :
- 2019
- Publisher :
- British Medical Association, 2019.
-
Abstract
- Objective To determine whether coronary computed tomography angiography (CTA) should be performed in patients with any clinical probability of coronary artery disease (CAD), and whether the diagnostic performance differs between subgroups of patients. Design Prospectively designed meta-analysis of individual patient data from prospective diagnostic accuracy studies. Data sources Medline, Embase, and Web of Science for published studies. Unpublished studies were identified via direct contact with participating investigators. Eligibility criteria for selecting studies Prospective diagnostic accuracy studies that compared coronary CTA with coronary angiography as the reference standard, using at least a 50% diameter reduction as a cutoff value for obstructive CAD. All patients needed to have a clinical indication for coronary angiography due to suspected CAD, and both tests had to be performed in all patients. Results had to be provided using 2×2 or 3×2 cross tabulations for the comparison of CTA with coronary angiography. Primary outcomes were the positive and negative predictive values of CTA as a function of clinical pretest probability of obstructive CAD, analysed by a generalised linear mixed model; calculations were performed including and excluding non-diagnostic CTA results. The no-treat/treat threshold model was used to determine the range of appropriate pretest probabilities for CTA. The threshold model was based on obtained post-test probabilities of less than 15% in case of negative CTA and above 50% in case of positive CTA. Sex, angina pectoris type, age, and number of computed tomography detector rows were used as clinical variables to analyse the diagnostic performance in relevant subgroups. Results Individual patient data from 5332 patients from 65 prospective diagnostic accuracy studies were retrieved. For a pretest probability range of 7-67%, the treat threshold of more than 50% and the no-treat threshold of less than 15% post-test probability were obtained using CTA. At a pretest probability of 7%, the positive predictive value of CTA was 50.9% (95% confidence interval 43.3% to 57.7%) and the negative predictive value of CTA was 97.8% (96.4% to 98.7%); corresponding values at a pretest probability of 67% were 82.7% (78.3% to 86.2%) and 85.0% (80.2% to 88.9%), respectively. The overall sensitivity of CTA was 95.2% (92.6% to 96.9%) and the specificity was 79.2% (74.9% to 82.9%). CTA using more than 64 detector rows was associated with a higher empirical sensitivity than CTA using up to 64 rows (93.4% v 86.5%, P=0.002) and specificity (84.4% v 72.6%, Pv 0.907 (0.897 to 0.916), Pv all other age groups) and was not significantly influenced by angina pectoris type (typical angina 0.895 (0.873 to 0.917), atypical angina 0.898 (0.884 to 0.913), non-anginal chest pain 0.884 (0.870 to 0.899), other chest discomfort 0.915 (0.897 to 0.934)). Conclusions In a no-treat/treat threshold model, the diagnosis of obstructive CAD using coronary CTA in patients with stable chest pain was most accurate when the clinical pretest probability was between 7% and 67%. Performance of CTA was not influenced by the angina pectoris type and was slightly higher in men and lower in older patients. Systematic review registration PROSPERO CRD42012002780.
- Subjects :
- Computed Tomography Angiography
stable chest pain
ACCURACY
Coronary Vessels/diagnostic imaging
Settore MED/11 - Malattie dell'Apparato Cardiovascolare
Coronary Artery Disease
2700 General Medicine
030204 cardiovascular system & hematology
Chest pain
BIVARIATE METAANALYSIS
Coronary artery disease
Angina
0302 clinical medicine
Positive predicative value
Medicine
030212 general & internal medicine
SPECIFICITY
Computed tomography angiography
Computed Tomography Angiography/methods
medicine.diagnostic_test
10042 Clinic for Diagnostic and Interventional Radiology
obstructive coronary artery disease
General Medicine
Coronary Vessels
3. Good health
PREVALENCE
Pre- and post-test probability
Predictive value of tests
Radiology
medicine.symptom
SENSITIVITY
INTERVENTIONS
Coronary Artery Disease/complications
medicine.medical_specialty
OF-CARDIOLOGY FOUNDATION
610 Medicine & health
computed tomography angiography (Englisch)
AMERICAN-COLLEGE
Angina Pectoris
03 medical and health sciences
Predictive Value of Tests
MANAGEMENT
Humans
cardiovascular diseases
Probability
CTA
business.industry
Research
Angina Pectoris/diagnostic imaging
10181 Clinic for Nuclear Medicine
PERFORMANCE
medicine.disease
Confidence interval
Feasibility Studies
business
Subjects
Details
- Language :
- English
- ISSN :
- 17561833
- Database :
- OpenAIRE
- Journal :
- BMJ (Clinical research ed.), Vol. 365, no. 8209, p. l1945 [1-15] (2019), Haase, R, Schlattmann, P, Gueret, P, Andreini, D, Pontone, G, Alkadhi, H, Hausleiter, J, Garcia, M J, Leschka, S, Meijboom, W B, Zimmermann, E, Gerber, B, Schoepf, U J, Shabestari, A A, Nørgaard, B L, Meijs, M F L, Sato, A, Ovrehus, K A, Diederichsen, A C P, Jenkins, S M M, Knuuti, J, Hamdan, A, Halvorsen, B A, Mendoza-Rodriguez, V, Rochitte, C E, Rixe, J, Wan, Y L, Langer, C, Bettencourt, N, Martuscelli, E, Ghostine, S, Buechel, R R, Nikolaou, K, Mickley, H, Yang, L, Zhang, Z, Chen, M Y, Halon, D A, Rief, M, Sun, K, Hirt-Moch, B, Niinuma, H, Marcus, R P, Muraglia, S, Jakamy, R, Chow, B J, Kaufmann, P A, Tardif, J-C, Nomura, C, Kofoed, K F & COME-CCT Consortium 2019, ' 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 ', B M J, vol. 365, l1945 . https://doi.org/10.1136/bmj.l1945, Haase, R, Schlattmann, P, Gueret, P, Andreini, D, Pontone, G, Alkadhi, H, Hausleiter, J, Garcia, M J, Leschka, S, Meijboom, W B, Zimmermann, E, Gerber, B, Schoepf, U J, Shabestari, A A, Nørgaard, B L, Meijs, M F L, Sato, A, Ovrehus, K A, Diederichsen, A C P, Jenkins, S M M, Knuuti, J, Hamdan, A, Halvorsen, B A, Mendoza-Rodriguez, V, Rochitte, C E, Rixe, J, Wan, Y L, Langer, C, Bettencourt, N, Martuscelli, E, Ghostine, S, Buechel, R R, Nikolaou, K, Mickley, H, Yang, L, Zhang, Z, Chen, M Y, Halon, D A, Rief, M, Sun, K, Hirt-Moch, B, Niinuma, H, Marcus, R P, Muraglia, S, Jakamy, R, Chow, B J, Kaufmann, P A, Tardif, J-C, Nomura, C, Kofoed, K F & COME-CCT Consortium 2019, ' 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 ', B M J, vol. 365, el1945 . https://doi.org/10.1136/bmj.l1945, Haase, R, Schlattmann, P, Gueret, P, Andreini, D, Pontone, G, Alkadhi, H, Hausleiter, J, Garcia, M J, Leschka, S, Meijboom, W B, Zimmermann, E, Gerber, B, Schoepf, U J, Shabestari, A A, Nørgaard, B L, Meijs, M F L, Sato, A, Ovrehus, K A, Diederichsen, A C P, Jenkins, S M M, Knuuti, J, Hamdan, A, Halvorsen, B A, Mendoza-Rodriguez, V, Rochitte, C E, Rixe, J, Wan, Y L, Langer, C, Bettencourt, N, Martuscelli, E, Ghostine, S, Buechel, R R, Nikolaou, K, Mickley, H, Yang, L, Zhang, Z, Chen, M Y, Halon, D A, Rief, M, Sun, K, Hirt-Moch, B, Niinuma, H, Marcus, R P, Muraglia, S, Jakamy, R, Chow, B J, Kaufmann, P A, Tardif, J C, Nomura, C, Kofoed, K F, Laissy, J P, Arbab-Zadeh, A, Kitagawa, K, Laham, R, Jinzaki, M, Hoe, J, Rybicki, F J, Scholte, A, Paul, N, Tan, S Y, Yoshioka, K, Röhle, R, Schuetz, G M, Schueler, S, Coenen, M H, Wieske, V, Achenbach, S, Budoff, M J, Laule, M, Newby, D E & Dewey, M 2019, ' 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 ', The BMJ, vol. 365, el1945 . https://doi.org/10.1136/bmj.l1945, British Medical Journal, 365. BMJ PUBLISHING GROUP, The BMJ, 2019, ' 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 ', British Medical Journal (BMJ), pp. l1945 . https://doi.org/10.1136/bmj.l1945, BMJ-British medical journal, 365:l1945. BMJ Publishing Group
- Accession number :
- edsair.doi.dedup.....750243bda089b676db06c19e97e62139