title: 64-Slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis.
abstract: BACKGROUND
  Coronary artery disease (CAD) is a major cause of mortality and ill health.
  
  
  OBJECTIVE
  To assess whether 64-slice CT angiography might replace some coronary angiography (CA) for diagnosis and assessment of CAD.
  
  
  METHODS
  Electronic databases, conference proceedings and reference lists of included studies.
  
  
  METHODS
  Eligible studies compared 64-slice CT with a reference standard of CA in adults with suspected/known CAD, reporting sensitivity and specificity or true and false positives and negatives.
  
  
  METHODS
  Two reviewers independently extracted data from included studies.
  
  
  RESULTS
  Forty studies were included; 28 provided sufficient data for inclusion in the meta-analyses, all using a cut off point of >/=50% stenosis to define significant CAD. In patient-based detection (n = 1286) 64-slice CT pooled sensitivity was 99% (95% credible interval (CrI) 97% to 99%), specificity 89% (95% CrI 83% to 94%), median positive predictive value (PPV) across studies 93% (range 64-100%) and negative predictive value (NPV) 100% (range 86-100%). In segment-based detection (n = 14 199) 64-slice CT pooled sensitivity was 90% (95% CrI 85% to 94%), specificity 97% (95% CrI 95% to 98%), median PPV across studies 76% (range 44-93%) and NPV 99% (range 95-100%).
  
  
  CONCLUSIONS
  64-Slice CT is highly sensitive for patient-based detection of CAD and has high NPV. An ability to rule out significant CAD means that it may have a role in the assessment of chest pain, particularly when the diagnosis remains uncertain despite clinical evaluation and simple non-invasive testing.
authors.affiliation: Health Services Research Unit, Institute of Applied Health Sciences, College of LifeSciences and Medicine, University of Aberdeen, Aberdeen, UK. g.mowatt@abdn.ac.uk
authors.forename: G
authors.initials: G
authors.lastname: Mowatt
authors.forename: J A
authors.initials: JA
authors.lastname: Cook
authors.forename: G S
authors.initials: GS
authors.lastname: Hillis
authors.forename: S
authors.initials: S
authors.lastname: Walker
authors.forename: C
authors.initials: C
authors.lastname: Fraser
authors.forename: X
authors.initials: X
authors.lastname: Jia
authors.forename: N
authors.initials: N
authors.lastname: Waugh
mesh_terms: D000368:Aged; D002114:Calcinosis / Q000000981:diagnostic imaging*; D002637:Chest Pain / Q000000981:diagnostic imaging* / Q000209:etiology; D017023:Coronary Angiography / Q000295:instrumentation* / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011856:Radiographic Image Enhancement; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*