Noninvasive coronary angiography with 64-channel multidetector computed tomography in patients with acute coronary syndrome

Ulimoen, Geir; Gjønnæss, Eyvind; Atar, Dan; Dahl, Tobias; Stranden, Einar; Sandbæk, Gunnar

doi:10.1080/02841850802452083

Cited by 10 publications

(4 citation statements)

References 16 publications

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“…We found 120 eligible studies8 9 19 20 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113…”

Section: Resultsunclassified

“…For 26 studies8 9 19 20 22 25 32 35 41 45 48 61 62 72 96 97 99 105 111 112 115 116 121 125 126 129 (including 2298 patients), it was possible to calculate alternative 3×2 tables (table 1). Sensitivity, area under the curve, and positive and negative likelihood ratios indicated significantly decreased diagnostic performance (P<0.05), compared with the 2×2 table (table 2).…”

Section: Resultsmentioning

confidence: 99%

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Use of 3x2 tables with an intention to diagnose approach to assess clinical performance of diagnostic tests: meta-analytical evaluation of coronary CT angiography studies

Schuetz

Schlattmann

Dewey

2012

BMJ

142

141

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Objective To determine whether a 3×2 table, using an intention to diagnose approach, is better than the "classic" 2×2 table at handling transparent reporting and non-evaluable results, when assessing the accuracy of a diagnostic test.Design Based on a systematic search for diagnostic accuracy studies of coronary computed tomography (CT) angiography, full texts of relevant studies were evaluated to determine whether they could calculate an alternative 3×2 table. To quantify an overall effect, we pooled diagnostic accuracy values according to a meta-analytical approach.Data sources Medline (via PubMed), Embase (via Ovid), and ISI Web of Science electronic databases. Eligibility criteria Prospective English or German language studies comparing coronary CT with conventional coronary angiography in all patients and providing sufficient data for a patient level analysis.Results 120 studies (10 287 patients) were eligible. Studies varied greatly in their approaches to handling non-evaluable findings. We found 26 studies (including 2298 patients) that allowed us to calculate both 2×2 tables and 3×2 tables. Using a bivariate random effects model, we compared the 2×2 table with the 3×2 table, and found significant differences for pooled sensitivity (98.2 (95% confidence interval 96.7 to 99.1) v 92.7 (88.5 to 95.3)), area under the curve (0.99 (0.98 to 1.00) v 0.93 (0.91 to 0.95)), positive likelihood ratio (9.1 (6.2 to 13.3) v 4.4 (3.3 to 6.0)), and negative likelihood ratio (0.02 (0.01 to 0.04) v 0.09 (0.06 to 0.15); (P<0.05)).Conclusion Parameters for diagnostic performance significantly decrease if non-evaluable results are included by a 3×2 table for analysis (intention to diagnose approach). This approach provides a more realistic picture of the clinical potential of diagnostic tests. IntroductionClinical decisions in medicine are largely made on the basis of information gained from diagnostic testing. Against the background of more than 15 years of development and experience in evidence based medicine 1 and in times of comparative effectiveness research, 2 new diagnostic techniques have to be critically assessed and proven to be effective before they can be used on a wide scale. Diagnostic accuracy studies comparing an index test with a reference or gold standard and meta-analyses combining the results of many individual studies to explore a test's diagnostic potential are an important and basic step in the overall evaluation process of the validity of a new diagnostic test. 3 4 However, previous studies have shown that methodological deficits could affect the estimated diagnostic accuracy of a test. 5-7In non-invasive coronary imaging, technical innovations such as dual source 8 and 320 row computed tomography (CT) 9 have improved spatial and temporal resolution while reducing radiation. As a result of these developments, CT has evolved into the primary modality for non-invasively evaluating native coronary arteries over the past 10 years.10 11 Cardiac CT examinations performed on newer generation scanners ...

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Section: Resultsunclassified

Section: Resultsmentioning

confidence: 99%

Use of 3x2 tables with an intention to diagnose approach to assess clinical performance of diagnostic tests: meta-analytical evaluation of coronary CT angiography studies

Schuetz

Schlattmann

Dewey

2012

BMJ

142

141

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“…In contrast, previous evaluating patients with suspected ACS showed variable results. Ulimoen et al [17], in a single-center trial, showed a lower than expected diagnostic performance of MDCTA compared with ICA in a patientbased analysis, with a high number of non-interpretable segments. On the other hand, Meijboom et al demonstrated a high diagnostic accuracy of MDCTA in ACS patients, in one single [16] and one multicenter trial [15].…”

Section: Diagnostic Accuracy In Patients With Suspected Acsmentioning

confidence: 97%

“…Based on the high diagnostic accuracy of multi-detector computed tomography angiography (MDCTA) to detect coronary stenosis in stable patients [3][4][5][6], some recent studies have evaluated this method as a diagnostic tool to distinguish patients with ACS from those with low-risk acute chest pain [7][8][9][10][11][12][13]. However, the clinical status, plaque characteristics and physiopathology are different between ACS and stable atherosclerosis and there are limited data evaluating the performance of MDCTA compared with invasive coronary angiography (ICA) specifically in an ACS population [14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Accuracy of multidetector computed tomography for detection of coronary artery stenosis in acute coronary syndrome compared with stable coronary disease: A CORE64 multicenter trial substudy

Sara

Rochitte

Lemos

et al. 2014

International Journal of Cardiology

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Influence of coronary artery disease prevalence on predictive values of coronary CT angiography: a meta-regression analysis

2011

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Noninvasive coronary angiography with 64-channel multidetector computed tomography in patients with acute coronary syndrome

Abstract: Limited diagnostic accuracy restricts the usefulness of coronary MDCT in patient groups with a high pretest probability of disease, such as in acute coronary syndrome.

Cited by 10 publications

References 16 publications

Use of 3x2 tables with an intention to diagnose approach to assess clinical performance of diagnostic tests: meta-analytical evaluation of coronary CT angiography studies

Use of 3x2 tables with an intention to diagnose approach to assess clinical performance of diagnostic tests: meta-analytical evaluation of coronary CT angiography studies

Accuracy of multidetector computed tomography for detection of coronary artery stenosis in acute coronary syndrome compared with stable coronary disease: A CORE64 multicenter trial substudy

Influence of coronary artery disease prevalence on predictive values of coronary CT angiography: a meta-regression analysis

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