Diagnostic Value of 320-Slice Coronary CT Angiography in Coronary Artery Disease: A Systematic Review and Meta-Analysis

The aim of this study is to perform a systematic review and meta-analysis of the diagnostic value of 320-slice coronary computed tomography (CT) angiography in the diagnosis of coronary artery disease when compared to invasive coronary angiography. A search of different databases was conducted to identify studies investigating the diagnostic value of 320-slice coronary CT angiography. Sensitivity, specificity, positive and negative predictive value estimates pooled across studies were tested using a fixed effects model and analysed at patient-, vessel-and segment-based assessment. Twelve studies comprising 1592 patients (median, 63 patients, range, 37-240 patients) with a total of 2974 vessels and 21623 segments met selection criteria for inclusion in the analysis. Patients with a high prevalence of coronary artery disease were included in more than 70% of these studies. The mean values and 95% confidence interval (CI) of sensitivity, specificity, positive predictive value and negative predictive value of 320-slice coronary CT angiography were 96.3% (95% CI: 92.9%, 99.8%), 86.4% (95% CI: 77.8%, 94.9%), 89.6% (95% CI: 85.6%, 93.6%) and 93.2% (95% CI: 84.1%, 100%), at patient-based analysis; 91.8% (95% CI: 85.8%, 97.8%), 95.4% (95% CI: 93.6%, 97.1%), 85.9% (95% CI: 79.7%, 92%) and 97.4% (95% CI: 95.9%, 99.1%), at vessel-based analysis; 86.2% (95% CI: 81.8%, 90.6%), 96.5% (95% CI: 95.2%, 98%), 79.9% (95% CI: 75.3%, 84.6%) and 97.8% (95% CI: 96.7%, 99%), at segment-based analysis, respectively. The mean effective dose of 320-slice coronary CT angiography was 10.5 mSv (95% CI: 6.1, 14.8 mSv). Diagnostic value of 320-slice coronary CT angiography was not affected by different heart rates and calcium scores (p>0.05). This analysis shows that 320-slice coronary CT angiography has high diagnostic value in patients with high coronary artery disease prevalence. Relatively high radiation dose is mainly due to inclusion of patients with high heart rates and without using the advanced dose-reduction techniques, thus, further dose-saving strategies should be implemented to minimise the resultant radiation dose.