Diagnostic accuracy of 320-slice computed tomography angiography for detection of coronary artery stenosis: Meta-analysis

Abstract Objective This study aims to review the recent literatures on the diagnostic accuracy of 320-slice computed tomography angiography (CTA) for detection of coronary artery stenosis, with invasive coronary angiography (ICA) as the reference standard. Methods A PubMed and EMBASE cross-search of the literatures on use of 320-slice CTA compared with ICA for detection of coronary artery stenosis, with publication date limited to January 1, 2008 to December 31, 2012. Individual and pooled sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated at the patient-, vessel- and segment-level. A positive result was defined as greater than or equal to 50%-diameter stenosis. Results A total of ten studies were included in the present meta-analysis, examining 1088 patients, 1629 vessels and 12,406 segments. The meta-analysis at the patient-level indicated a pooled sensitivity of 93% (95%CI: 91%–95%), specificity of 86% (95%CI: 82%–89%), PPV of 90% (95%CI: 87%–92%) and NPV of 90% (95%CI: 87%–93%). At the vessel-level, the pooled sensitivity was 92% (95%CI: 89%–94%), specificity 95% (95%CI: 94%–96%), PPV 87% (95%CI: 83%–90%), and NPV 97% (95%CI: 96%–98%). At the segment-level, the pooled sensitivity was 78% (95%CI: 76%–80%), specificity 98% (95%CI: 97%–98%), PPV 82% (95%CI: 80%–84%), and NPV 97% (95%CI: 97%–97%). Conclusions 320-CTA can effectively identify the majority of patients with coronary artery disease (CAD). The high NPV makes it as an effective noninvasive alternative to ICA for the exclusion of stenosis.