The diagnostic accuracy and outcomes after coronary computed tomography angiography vs. conventional functional testing in patients with stable angina pectoris: a systematic review and meta-analysis

Aims: To systematically review and 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 CTA vs. 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