title: Diagnostic accuracy of 64-slice computed tomography coronary angiography for the detection of in-stent restenosis: a meta-analysis.
abstract: BACKGROUND
  We sought to evaluate the diagnostic accuracy of 64-slice multi-detector row computed tomography (MDCT) compared with invasive coronary angiography for in-stent restenosis (ISR) detection.
  
  
  METHODS
  MEDLINE, Cochrane library, and BioMed Central database searches were performed until April 2009 for original articles. Inclusion criteria were (1) 64-MDCT was used as a diagnostic test for ISR, with >50% diameter stenosis selected as the cut-off criterion for significant ISR, using invasive coronary angiography and quantitative coronary angiography as the standard of reference; (2) absolute numbers of true positive, false positive, true negative, and false negative results could be derived. Standard meta-analytic methods were applied.
  
  
  RESULTS
  Nine studies with a total of 598 patients with 978 stents included were considered eligible. On average, 9% of stents were unassessable (range 0-42%). Accuracy tests with 95% confidence intervals (CIs) comparing 64-MDCT vs invasive coronary angiography showed that pooled sensitivity, specificity, positive and negative likelihood ratio (random effect model) values were: 86% (95% CI 80-91%), 93% (95% CI 91-95%), 12.32 (95% CI 7.26-20.92), 0.18 (95% CI 0.12-0.28) for binary ISR detection. The symmetric area under the curve value was 0.94, indicating good agreement between 64-MDCT and invasive coronary angiography.
  
  
  CONCLUSIONS
  64-MDCT has a good diagnostic accuracy for ISR detection with a particularly high negative predictive value. However, still a relatively large proportion of stents remains uninterpretable. Accordingly, only in selected patients, 64-MDCT may serve as a potential alternative noninvasive method to rule out ISR.
authors.affiliation: Division of Cardiology, Careggi Hospital, V.le Morgagni, 85 Florence, Italy. carddept@tin.it
authors.forename: Nazario
authors.initials: N
authors.lastname: Carrabba
authors.forename: Joanne D
authors.initials: JD
authors.lastname: Schuijf
authors.forename: Fleur R
authors.initials: FR
authors.lastname: de Graaf
authors.forename: Guido
authors.initials: G
authors.lastname: Parodi
authors.forename: Erica
authors.initials: E
authors.lastname: Maffei
authors.forename: Renato
authors.initials: R
authors.lastname: Valenti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Palumbo
authors.forename: Annick C
authors.initials: AC
authors.lastname: Weustink
authors.forename: Nico R
authors.initials: NR
authors.lastname: Mollet
authors.forename: Gabriele
authors.initials: G
authors.lastname: Accetta
authors.forename: Filippo
authors.initials: F
authors.lastname: Cademartiri
authors.forename: David
authors.initials: D
authors.lastname: Antoniucci
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
mesh_terms: D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging*; D006801:Humans; D012372:ROC Curve; D012680:Sensitivity and Specificity; D015607:Stents; D014057:Tomography, X-Ray Computed