Diagnostic accuracy of 64-slice computed tomography coronary angiography for the detection of in-stent restenosis: a meta-analysis.
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.
Carrabba
Nazario
N
Division of Cardiology, Careggi Hospital, V.le Morgagni, 85 Florence, Italy. carddept@tin.it
Schuijf
Joanne D
JD
de Graaf
Fleur R
FR
Parodi
Guido
G
Maffei
Erica
E
Valenti
Renato
R
Palumbo
Alessandro
A
Weustink
Annick C
AC
Mollet
Nico R
NR
Accetta
Gabriele
G
Cademartiri
Filippo
F
Antoniucci
David
D
Bax
Jeroen J
JJ
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