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：本研究以有创血流储备分数（invasive fractional flow reserve, FFR）作为冠状动脉疾病（coronary artery disease, CAD）诊断的金标准，旨在评估各类无创检测手段的诊断效能。方法：检索截至2017年3月发表的、针对疑似CAD患者对比无创检测与有创FFR的相关研究，检索范围涵盖Medline、Embase数据库，以及相关研究的文章、指南与综述的参考文献。结果：共77项研究符合纳入标准。在检测功能显著性冠状动脉病变的敏感性方面，冠状动脉CT血管造影（coronary computed tomography angiography, CT angiography）位列第一，敏感度为88%（95%置信区间85%~90%），其后依次为冠状动脉CT血管造影衍生的血流储备分数（FFRCT）[85%（95%置信区间81%~88%）]、正电子发射断层显像（positron emission tomography, PET）[85%（95%置信区间82%~88%）]、负荷心脏磁共振（stress cardiac magnetic resonance, stress CMR）[81%（95%置信区间79%~84%）]、联合冠状动脉CT血管造影的负荷心肌CT灌注[79%（95%置信区间74%~83%）]、负荷心肌CT灌注[77%（95%置信区间73%~80%）]、负荷超声心动图（stress echocardiography, Echo）[72%（95%置信区间64%~78%）]以及负荷单光子发射计算机断层扫描（stress single-photon emission computed tomography, SPECT）[64%（95%置信区间60%~68%）]。在排除CAD的特异性方面，联合冠状动脉CT血管造影的负荷心肌CT灌注[91%（95%置信区间88%~93%）]、负荷心脏磁共振[91%（95%置信区间90%~93%）]及PET[87%（95%置信区间86%~89%）]表现最优。结论：相较于其他指标检测，阴性冠状动脉CT血管造影结果在排除具有临床意义的CAD方面具有更优的诊断效能；而联合冠状动脉CT血管造影的负荷心肌CT灌注、负荷心脏磁共振及PET的阳性结果，在识别需接受侵入性冠状动脉评估的患者方面表现更佳。