Peter Schlattmann, Viktoria Wieske, Keno K Bressem, Theresa Götz, Georg M Schuetz, Daniele Andreini, Gianluca Pontone, Hatem Alkadhi, Jörg Hausleiter, Elke Zimmermann, Bernhard Gerber, Abbas A Shabestari, Matthijs F L Meijs, Akira Sato, Kristian A Øvrehus, Shona M M Jenkins, Juhani Knuuti, Ashraf Hamdan, Bjørn A Halvorsen, Vladimir Mendoza-Rodriguez, Johannes Rixe, Yung-Liang Wan, Christoph Langer, Sebastian Leschka, Eugenio Martuscelli, Said Ghostine, Jean-Claude Tardif, Alejandra Rodríguez Sánchez, Robert Haase, Marc Dewey
{"title":"冠状动脉计算机断层扫描血管造影和功能测试诊断阻塞性冠状动脉疾病的有效性：心脏计算机断层扫描（COME-CCT）个体患者数据协作元分析的结果。","authors":"Peter Schlattmann, Viktoria Wieske, Keno K Bressem, Theresa Götz, Georg M Schuetz, Daniele Andreini, Gianluca Pontone, Hatem Alkadhi, Jörg Hausleiter, Elke Zimmermann, Bernhard Gerber, Abbas A Shabestari, Matthijs F L Meijs, Akira Sato, Kristian A Øvrehus, Shona M M Jenkins, Juhani Knuuti, Ashraf Hamdan, Bjørn A Halvorsen, Vladimir Mendoza-Rodriguez, Johannes Rixe, Yung-Liang Wan, Christoph Langer, Sebastian Leschka, Eugenio Martuscelli, Said Ghostine, Jean-Claude Tardif, Alejandra Rodríguez Sánchez, Robert Haase, Marc Dewey","doi":"10.1186/s13244-024-01702-y","DOIUrl":null,"url":null,"abstract":"<p><strong>Aim: </strong>To determine the effectiveness of functional stress testing and computed tomography angiography (CTA) for diagnosis of obstructive coronary artery disease (CAD).</p><p><strong>Methods and results: </strong>Two-thousand nine-hundred twenty symptomatic stable chest pain patients were included in the international Collaborative Meta-Analysis of Cardiac CT consortium to compare CTA with exercise electrocardiography (exercise-ECG) and single-photon emission computed tomography (SPECT) for diagnosis of CAD defined as ≥ 50% diameter stenosis by invasive coronary angiography (ICA) as reference standard. Generalised linear mixed models were used for calculating the diagnostic accuracy of each diagnostic test including non-diagnostic results as dependent variables in a logistic regression model with random intercepts and slopes. Covariates were the reference standard ICA, the type of diagnostic method, and their interactions. CTA showed significantly better diagnostic performance (p < 0.0001) with a sensitivity of 94.6% (95% CI 92.7-96) and a specificity of 76.3% (72.2-80) compared to exercise-ECG with 54.9% (47.9-61.7) and 60.9% (53.4-66.3), SPECT with 72.9% (65-79.6) and 44.9% (36.8-53.4), respectively. The positive predictive value of CTA was ≥ 50% in patients with a clinical pretest probability of 10% or more while this was the case for ECG and SPECT at pretest probabilities of ≥ 40 and 28%. CTA reliably excluded obstructive CAD with a post-test probability of below 15% in patients with a pretest probability of up to 74%.</p><p><strong>Conclusion: </strong>In patients with stable chest pain, CTA is more effective than functional testing for the diagnosis as well as for reliable exclusion of obstructive CAD. CTA should become widely adopted in patients with intermediate pretest probability.</p><p><strong>Systematic review registration: </strong>PROSPERO Database for Systematic Reviews-CRD42012002780.</p><p><strong>Critical relevance statement: </strong>In symptomatic stable chest pain patients, coronary CTA is more effective than functional testing for diagnosis and reliable exclusion of obstructive CAD in intermediate pretest probability of CAD.</p><p><strong>Key points: </strong>Coronary computed tomography angiography showed significantly better diagnostic performance (p < 0.0001) for diagnosis of coronary artery disease compared to exercise-ECG and SPECT. The positive predictive value of coronary computed tomography angiography was ≥ 50% in patients with a clinical pretest probability of at least 10%, for ECG ≥ 40%, and for SPECT 28%. Coronary computed tomography angiography reliably excluded obstructive coronary artery disease with a post-test probability of below 15% in patients with a pretest probability of up to 74%.</p>","PeriodicalId":13639,"journal":{"name":"Insights into Imaging","volume":"15 1","pages":"208"},"PeriodicalIF":4.1000,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11324632/pdf/","citationCount":"0","resultStr":"{\"title\":\"The effectiveness of coronary computed tomography angiography and functional testing for the diagnosis of obstructive coronary artery disease: results from the individual patient data Collaborative Meta-Analysis of Cardiac CT (COME-CCT).\",\"authors\":\"Peter Schlattmann, Viktoria Wieske, Keno K Bressem, Theresa Götz, Georg M Schuetz, Daniele Andreini, Gianluca Pontone, Hatem Alkadhi, Jörg Hausleiter, Elke Zimmermann, Bernhard Gerber, Abbas A Shabestari, Matthijs F L Meijs, Akira Sato, Kristian A Øvrehus, Shona M M Jenkins, Juhani Knuuti, Ashraf Hamdan, Bjørn A Halvorsen, Vladimir Mendoza-Rodriguez, Johannes Rixe, Yung-Liang Wan, Christoph Langer, Sebastian Leschka, Eugenio Martuscelli, Said Ghostine, Jean-Claude Tardif, Alejandra Rodríguez Sánchez, Robert Haase, Marc Dewey\",\"doi\":\"10.1186/s13244-024-01702-y\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aim: </strong>To determine the effectiveness of functional stress testing and computed tomography angiography (CTA) for diagnosis of obstructive coronary artery disease (CAD).</p><p><strong>Methods and results: </strong>Two-thousand nine-hundred twenty symptomatic stable chest pain patients were included in the international Collaborative Meta-Analysis of Cardiac CT consortium to compare CTA with exercise electrocardiography (exercise-ECG) and single-photon emission computed tomography (SPECT) for diagnosis of CAD defined as ≥ 50% diameter stenosis by invasive coronary angiography (ICA) as reference standard. Generalised linear mixed models were used for calculating the diagnostic accuracy of each diagnostic test including non-diagnostic results as dependent variables in a logistic regression model with random intercepts and slopes. Covariates were the reference standard ICA, the type of diagnostic method, and their interactions. CTA showed significantly better diagnostic performance (p < 0.0001) with a sensitivity of 94.6% (95% CI 92.7-96) and a specificity of 76.3% (72.2-80) compared to exercise-ECG with 54.9% (47.9-61.7) and 60.9% (53.4-66.3), SPECT with 72.9% (65-79.6) and 44.9% (36.8-53.4), respectively. The positive predictive value of CTA was ≥ 50% in patients with a clinical pretest probability of 10% or more while this was the case for ECG and SPECT at pretest probabilities of ≥ 40 and 28%. CTA reliably excluded obstructive CAD with a post-test probability of below 15% in patients with a pretest probability of up to 74%.</p><p><strong>Conclusion: </strong>In patients with stable chest pain, CTA is more effective than functional testing for the diagnosis as well as for reliable exclusion of obstructive CAD. CTA should become widely adopted in patients with intermediate pretest probability.</p><p><strong>Systematic review registration: </strong>PROSPERO Database for Systematic Reviews-CRD42012002780.</p><p><strong>Critical relevance statement: </strong>In symptomatic stable chest pain patients, coronary CTA is more effective than functional testing for diagnosis and reliable exclusion of obstructive CAD in intermediate pretest probability of CAD.</p><p><strong>Key points: </strong>Coronary computed tomography angiography showed significantly better diagnostic performance (p < 0.0001) for diagnosis of coronary artery disease compared to exercise-ECG and SPECT. 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Coronary computed tomography angiography reliably excluded obstructive coronary artery disease with a post-test probability of below 15% in patients with a pretest probability of up to 74%.</p>\",\"PeriodicalId\":13639,\"journal\":{\"name\":\"Insights into Imaging\",\"volume\":\"15 1\",\"pages\":\"208\"},\"PeriodicalIF\":4.1000,\"publicationDate\":\"2024-08-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11324632/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Insights into Imaging\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s13244-024-01702-y\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Insights into Imaging","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s13244-024-01702-y","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
The effectiveness of coronary computed tomography angiography and functional testing for the diagnosis of obstructive coronary artery disease: results from the individual patient data Collaborative Meta-Analysis of Cardiac CT (COME-CCT).
Aim: To determine the effectiveness of functional stress testing and computed tomography angiography (CTA) for diagnosis of obstructive coronary artery disease (CAD).
Methods and results: Two-thousand nine-hundred twenty symptomatic stable chest pain patients were included in the international Collaborative Meta-Analysis of Cardiac CT consortium to compare CTA with exercise electrocardiography (exercise-ECG) and single-photon emission computed tomography (SPECT) for diagnosis of CAD defined as ≥ 50% diameter stenosis by invasive coronary angiography (ICA) as reference standard. Generalised linear mixed models were used for calculating the diagnostic accuracy of each diagnostic test including non-diagnostic results as dependent variables in a logistic regression model with random intercepts and slopes. Covariates were the reference standard ICA, the type of diagnostic method, and their interactions. CTA showed significantly better diagnostic performance (p < 0.0001) with a sensitivity of 94.6% (95% CI 92.7-96) and a specificity of 76.3% (72.2-80) compared to exercise-ECG with 54.9% (47.9-61.7) and 60.9% (53.4-66.3), SPECT with 72.9% (65-79.6) and 44.9% (36.8-53.4), respectively. The positive predictive value of CTA was ≥ 50% in patients with a clinical pretest probability of 10% or more while this was the case for ECG and SPECT at pretest probabilities of ≥ 40 and 28%. CTA reliably excluded obstructive CAD with a post-test probability of below 15% in patients with a pretest probability of up to 74%.
Conclusion: In patients with stable chest pain, CTA is more effective than functional testing for the diagnosis as well as for reliable exclusion of obstructive CAD. CTA should become widely adopted in patients with intermediate pretest probability.
Systematic review registration: PROSPERO Database for Systematic Reviews-CRD42012002780.
Critical relevance statement: In symptomatic stable chest pain patients, coronary CTA is more effective than functional testing for diagnosis and reliable exclusion of obstructive CAD in intermediate pretest probability of CAD.
Key points: Coronary computed tomography angiography showed significantly better diagnostic performance (p < 0.0001) for diagnosis of coronary artery disease compared to exercise-ECG and SPECT. The positive predictive value of coronary computed tomography angiography was ≥ 50% in patients with a clinical pretest probability of at least 10%, for ECG ≥ 40%, and for SPECT 28%. Coronary computed tomography angiography reliably excluded obstructive coronary artery disease with a post-test probability of below 15% in patients with a pretest probability of up to 74%.
期刊介绍：
Insights into Imaging (I³) is a peer-reviewed open access journal published under the brand SpringerOpen. All content published in the journal is freely available online to anyone, anywhere!
I³ continuously updates scientific knowledge and progress in best-practice standards in radiology through the publication of original articles and state-of-the-art reviews and opinions, along with recommendations and statements from the leading radiological societies in Europe.
Founded by the European Society of Radiology (ESR), I³ creates a platform for educational material, guidelines and recommendations, and a forum for topics of controversy.
A balanced combination of review articles, original papers, short communications from European radiological congresses and information on society matters makes I³ an indispensable source for current information in this field.
I³ is owned by the ESR, however authors retain copyright to their article according to the Creative Commons Attribution License (see Copyright and License Agreement). All articles can be read, redistributed and reused for free, as long as the author of the original work is cited properly.
The open access fees (article-processing charges) for this journal are kindly sponsored by ESR for all Members.
The journal went open access in 2012, which means that all articles published since then are freely available online.
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