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首页> 外文期刊>European heart journal cardiovascular Imaging >The diagnostic accuracy and outcomes after coronary computed tomography angiography vs. conventional functional testing in patients with stable angina pectoris: A systematic review andmeta-analysis
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The diagnostic accuracy and outcomes after coronary computed tomography angiography vs. conventional functional testing in patients with stable angina pectoris: A systematic review andmeta-analysis

机译：稳定型心绞痛患者冠状动脉计算机断层扫描血管造影与常规功能检查后的诊断准确性和结果：系统评价和荟萃分析

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Aims To systematically reviewand perform a meta-analysis of the diagnostic accuracy and post-test outcomes of conventional exercise electrocardiography (XECG) and single-photon emission computed tomography (SPECT) compared with coronary computed tomography angiography (coronary CTA) in patients suspected of stable coronary artery disease (CAD). Methods and results We systematically searched for studies published from January 2002 to February 2013 examining the diagnostic accuracy (defined as at least ≥50% luminal obstruction on invasive coronary angiography) and outcomes of coronary CTA (≥16 slice) in comparison with XECG and SPECT. The search revealed 11 eligible studies (N = 1575) comparing the diagnostic accuracy and 7 studies (N = 216.603) the outcomes of coronary CTA vs. XECG or/and SPECT. The per-patient sensitivity [95% confidence interval (95% CI)] to identify significant CAD was 98% (93-99%) for coronary CTAvs. 67% (54- 78%) (P< 0.001) for XECG and 99% (96-100%) vs. 73% (59-83%) (P = 0.001) for SPECT. The specificity (95% CI) of coronary CTA was 82% (63-93%) vs. 46% (30-64%) (P< 0.001) for XECG and 71% (60-80%) vs. 48% (31-64%) (P = 0.14) for SPECT. The odds ratio (OR) of downstream test utilization (DTU) for coronary CTA vs. XECG/SPECT was 1.38 (1.33-1.43, P< 0.001), for revascularization 2.63 (2.50-2.77, P< 0.001), for non-fatal myocardial infarction 0.53 (0.39-0.72, P< 0.001), and for all-cause mortality 1.01 (0.87-1.18, P = 0.87). Conclusion The up-front diagnostic performance of coronary CTA is higher than of XECG and SPECT. When compared with XECG/ SPECT testing, coronary CTA testing is associated with increased DTU and coronary revascularization.
机译：目的：系统评价常规运动心电图（XECG）和单光子发射计算机断层扫描（SPECT）与冠状动脉计算机断层造影血管造影（冠状动脉CTA）的诊断准确性和测试后结果的关系，并进行荟萃分析。冠状动脉疾病（CAD）。方法和结果我们系统地搜索了2002年1月至2013年2月发表的研究，以与XECG和SPECT进行比较，诊断准确性（定义为侵入性冠状动脉造影术中至少≥50％的管腔阻塞）和冠状动脉CTA的结果（≥16片） 。搜索显示11项符合条件的研究（N = 1575）比较了诊断的准确性，而7项研究（N = 216.603）比较了冠状动脉CTA与XECG或/和SPECT的结果。对于冠状动脉CTAvs，识别显着CAD的每位患者敏感性[95％置信区间（95％CI）]为98％（93-99％）。 XECG为67％（54-78％）（P <0.001），而SPECT为99％（96-100％），而73％（59-83％）（P = 0.001）。冠状动脉CTA的特异性（95％CI）为82％（63-93％），而XECG为46％（30-64％）（P <0.001），71％（60-80％）对48％（ SPECT为31-64％）（P = 0.14）。冠脉CTA与XECG / SPECT的下游测试利用率（DTU）的比值比（OR）为1.38（1.33-1.43，P <0.001），血运重建为2.63（2.50-2.77，P <0.001），非致命性心肌梗塞0.53（0.39-0.72，P <0.001），全因死亡率1.01（0.87-1.18，P = 0.87）。结论冠状动脉CTA的前期诊断性能优于XECG和SPECT。与XECG / SPECT测试相比，冠状动脉CTA测试与DTU增加和冠状动脉血运重建相关。

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