Diagnostic performance of non-invasive imaging for stable coronary artery disease: A Meta-analysis

Background: To determine diagnostic performance of non-invasive tests using invasive fractional flow reserve (FFR) as reference standard for coronary artery disease (CAD). Methods: Medline, Embase, and citations of articles, guidelines, and reviews for studies were used to compare non-invasive tests with invasive FFR for suspected CAD published through March 2017. Results: Seventy-seven studies met inclusion criteria. The diagnostic test with the highest sensitivity to detect a functionally significant coronary lesion was coronary computed tomography (CT) angiography [88%(85%-90%)], followed by FFR derived from coronary CT angiography (FFRCT) [85%(81%-88%)], positron emission tomography (PET) [85%(82%-88%)], stress cardiac magnetic resonance (stress CMR) [81%(79%-84%)], stress myocardial CT perfusion combined with coronary CT angiography [79%(74%-83%)], stress myocardial CT perfusion [77%(73%-80%)], stress echocardiography (Echo) [72%(64%-78%)] and stress single-photon emission computed tomography (SPECT) [64%(60%-68%)]. Specificity to rule out CAD was highest for stress myocardial CT perfusion added to coronary CT angiography [91%(88%-93%)], stress CMR [91%(90%-93%)], and PET [87%(86%-89%)]. Conclusion. A negative coronary CT angiography has a higher test performance than other index tests to exclude clinically-important CAD. A positive stress myocardial CT perfusion added to coronary CT angiography, stress cardiac MR, and PET have a higher test performance to identify patients requiring invasive coronary artery evaluation.

背景：本研究的目的是评估非侵入性检测在冠状动脉疾病（CAD）诊断中的性能，以侵入性分数血流储备（FFR）作为参考标准。方法：通过检索Medline、Embase数据库以及相关文章、指南和综述的引用，对至2017年3月发表的疑似CAD的非侵入性检测与侵入性FFR进行了比较。结果：共77项研究符合纳入标准。在检测功能上有意义的冠状动脉病变方面，诊断测试的敏感性最高的是冠状动脉计算机断层扫描（CT）血管造影[88%（85%-90%）]，其次是冠状动脉CT血管造影（FFRCT）推导出的FFR[85%（81%-88%）]，正电子发射断层扫描（PET）[85%（82%-88%）]，应激性心脏磁共振（stress CMR）[81%（79%-84%）]，应激性心肌CT灌注与冠状动脉CT血管造影相结合[79%（74%-83%）]，应激性心肌CT灌注[77%（73%-80%）]，应激性超声心动图（Echo）[72%（64%-78%）]以及应激性单光子发射计算机断层扫描（SPECT）[64%（60%-68%）]。在排除CAD的特异性方面，应激性心肌CT灌注与冠状动脉CT血管造影相结合[91%（88%-93%）]，应激性CMR[91%（90%-93%）]和PET[87%（86%-89%）]表现最佳。结论：冠状动脉CT血管造影的阴性结果在排除临床相关CAD方面具有比其他指标更高的测试性能。冠状动脉CT血管造影、应激性心肌CT灌注、应激性心脏磁共振和PET的阳性结果在识别需要侵入性冠状动脉评估的患者方面具有更高的测试性能。