1. Diagnosis of obstructive coronary artery disease using computed tomography angiography in patients with stable chest pain depending on clinical probability and in clinically important subgroups: Meta-analysis of individual patient data
- Author
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Haase, R. (Robert), Schlattmann, P. (Peter), Gueret, P. (Pascal), Andreini, D. (Daniele), Pontone, G. (Gianluca), Alkadhi, H. (Hatem), Hausleiter, J. (Jörg), Garcia, M. (Mario), Leschka, S. (Sebastian), Meijboom, W.B. (Willem Bob), Zimmermann, E. (Elke), Gerber, B. (Bernhard), Schoepf, U.J. (Joseph), Shabestari, A.A. (Abbas A), Nørgaard, B. (Bjarne), Meijs, M.F.L. (Matthijs), Sato, A. (Akira), Altern Ovrehus, K. (Kristian), Diederichsen, A.C.P. (Axel C P), Jenkins, S.M.M. (Shona), Knuuti, J. (Juhani), Hamdan, A. (Ashraf), Halvorsen, B.A. (Bjørn Arild), Mendoza-Rodriguez, V. (Vladimir), Rochitte, C. (Carlos), Rixe, J. (Johannes), Wan, Y.L. (Yung Liang), Langer, C. (Christoph), Bettencourt, N. (Nuno), Martuscelli, E. (Eugenio), Ghostine, S. (Said), Buechel, R.R. (Ronny Ralf), Nikolaou, K. (Konstantin), Mickley, H. (Hans), Yang, L. (Lin), Zhang, Z. (Zhaqoi), Chen, M.Y. (Marcus Y), Halon, D.A. (David), Rief, M. (Matthias), Sun, K. (Kai), Hirt-Moch, B. (Beatrice), Niinuma, H. (Hiroyuki), Marcus, R.P. (Roy P), Muraglia, S. (Simone), Jakamy, R. (Reda), Chow, B.J.W. (Benjamin), Kaufmann, P.A. (Philipp), Tardif, J.-C. (Jean-Claude), Nomura, C.H. (Cesar), Kofoed, K.F. (Klaus F), Laissy, J.-P. (Jean-Pierre), Arbab-Zadeh, A. (Armin), Kitagawa, K. (Kakuya), Laham, R. (Roger), Jinzaki, M. (Masahiro), Hoe, J. (John), Rybicki, F.J. (Frank J), Scholte, A. (Arthur), Paul, N. (Narinder), Tan, S.Y. (Swee Y), Yoshioka, K. (Kunihiro), Röhle, R. (Robert), Schuetz, G.M. (Georg), Schueler, S. (Sabine), Coenen, M.H. (Maria H), Wieske, V. (Viktoria), Achenbach, S. (Stephan), Budoff, M.J. (Matthew), Laule, M. (Michael), Newby, D.E. (David E.), Dewey, T.M. (Todd M.), Haase, R. (Robert), Schlattmann, P. (Peter), Gueret, P. (Pascal), Andreini, D. (Daniele), Pontone, G. (Gianluca), Alkadhi, H. (Hatem), Hausleiter, J. (Jörg), Garcia, M. (Mario), Leschka, S. (Sebastian), Meijboom, W.B. (Willem Bob), Zimmermann, E. (Elke), Gerber, B. (Bernhard), Schoepf, U.J. (Joseph), Shabestari, A.A. (Abbas A), Nørgaard, B. (Bjarne), Meijs, M.F.L. (Matthijs), Sato, A. (Akira), Altern Ovrehus, K. (Kristian), Diederichsen, A.C.P. (Axel C P), Jenkins, S.M.M. (Shona), Knuuti, J. (Juhani), Hamdan, A. (Ashraf), Halvorsen, B.A. (Bjørn Arild), Mendoza-Rodriguez, V. (Vladimir), Rochitte, C. (Carlos), Rixe, J. (Johannes), Wan, Y.L. (Yung Liang), Langer, C. (Christoph), Bettencourt, N. (Nuno), Martuscelli, E. (Eugenio), Ghostine, S. (Said), Buechel, R.R. (Ronny Ralf), Nikolaou, K. (Konstantin), Mickley, H. (Hans), Yang, L. (Lin), Zhang, Z. (Zhaqoi), Chen, M.Y. (Marcus Y), Halon, D.A. (David), Rief, M. (Matthias), Sun, K. (Kai), Hirt-Moch, B. (Beatrice), Niinuma, H. (Hiroyuki), Marcus, R.P. (Roy P), Muraglia, S. (Simone), Jakamy, R. (Reda), Chow, B.J.W. (Benjamin), Kaufmann, P.A. (Philipp), Tardif, J.-C. (Jean-Claude), Nomura, C.H. (Cesar), Kofoed, K.F. (Klaus F), Laissy, J.-P. (Jean-Pierre), Arbab-Zadeh, A. (Armin), Kitagawa, K. (Kakuya), Laham, R. (Roger), Jinzaki, M. (Masahiro), Hoe, J. (John), Rybicki, F.J. (Frank J), Scholte, A. (Arthur), Paul, N. (Narinder), Tan, S.Y. (Swee Y), Yoshioka, K. (Kunihiro), Röhle, R. (Robert), Schuetz, G.M. (Georg), Schueler, S. (Sabine), Coenen, M.H. (Maria H), Wieske, V. (Viktoria), Achenbach, S. (Stephan), Budoff, M.J. (Matthew), Laule, M. (Michael), Newby, D.E. (David E.), and Dewey, T.M. (Todd M.)
- Abstract
Objective To determine whether coronary computed tomography angiography (CTA) should be performed in patients with any clinical probability of coronary artery disease (CAD), and whether the diagnostic performance differs between subgroups of patients. Design Prospectively designed meta-analysis of individual patient data from prospective diagnostic accuracy studies. Data sources Medline, Embase, and Web of Science for published studies. Unpublished studies were identified via direct contact with participating investigators. Eligibility criteria for selecting studies Prospective diagnostic accuracy studies that compared coronary CTA with coronary angiography as the reference standard, using at least a 50% diameter reduction as a cutoff value for obstructive CAD. All patients needed to have a clinical indication for coronary angiography due to suspected CAD, and both tests had to be performed in all patients. Results had to be provided using 2×2 or 3×2 cross tabulations for the comparison of CTA with coronary angiography. Primary outcomes were the positive and negative predictive values of CTA as a function of clinical pretest probability of obstructive CAD, analysed by a generalised linear mixed model; calculations were performed including and excluding non-diagnostic CTA results. The no-treat/treat threshold model was used to determine the range of appropriate pretest probabilities for CTA. The threshold model was based on obtained post-test probabilities of less than 15% in case of negative CTA and above 50% in case of positive CTA. Sex, angina pectoris type, age, and number of computed tomography detector rows were used as clinical variables to analyse the diagnostic performance in relevant subgroups. Results Individual patient data from 5332 patients from 65 prospective diagnostic accuracy studies were retrieved. For a pretest probability range of 7-67%, the treat threshold of more than 50% and the no-treat threshold of less than 15% post-test probability were ob
- Published
- 2019
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