title: The diagnostic accuracy and outcomes after coronary computed tomography angiography vs. conventional functional testing in patients with stable angina pectoris: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To systematically review and perform a meta-analysis of the diagnostic accuracy and post-test outcomes of conventional exercise electrocardiography (XECG) and single-photon emission computed tomography (SPECT) compared with coronary computed tomography angiography (coronary CTA) in patients suspected of stable coronary artery disease (CAD).
  
  
  RESULTS
  We systematically searched for studies published from January 2002 to February 2013 examining the diagnostic accuracy (defined as at least ≥50% luminal obstruction on invasive coronary angiography) and outcomes of coronary CTA (≥16 slice) in comparison with XECG and SPECT. The search revealed 11 eligible studies (N = 1575) comparing the diagnostic accuracy and 7 studies (N = 216.603) the outcomes of coronary CTA vs. XECG or/and SPECT. The per-patient sensitivity [95% confidence interval (95% CI)] to identify significant CAD was 98% (93-99%) for coronary CTA vs. 67% (54-78%) (P < 0.001) for XECG and 99% (96-100%) vs. 73% (59-83%) (P = 0.001) for SPECT. The specificity (95% CI) of coronary CTA was 82% (63-93%) vs. 46% (30-64%) (P < 0.001) for XECG and 71% (60-80%) vs. 48% (31-64%) (P = 0.14) for SPECT. The odds ratio (OR) of downstream test utilization (DTU) for coronary CTA vs. XECG/SPECT was 1.38 (1.33-1.43, P < 0.001), for revascularization 2.63 (2.50-2.77, P < 0.001), for non-fatal myocardial infarction 0.53 (0.39-0.72, P < 0.001), and for all-cause mortality 1.01 (0.87-1.18, P = 0.87).
  
  
  CONCLUSIONS
  The up-front diagnostic performance of coronary CTA is higher than of XECG and SPECT. When compared with XECG/SPECT testing, coronary CTA testing is associated with increased DTU and coronary revascularization.
authors.affiliation: Department of Cardiology, Lillebaelt Hospital, Kabbeltoft 25, Vejle 7100, Denmark lenehuche@gmail.com.
authors.forename: Lene H
authors.initials: LH
authors.lastname: Nielsen
authors.affiliation: Division of Cardiology, Department of Medicine, Glostrup University Hospital, Glostrup, Denmark.
authors.forename: Nino
authors.initials: N
authors.lastname: Ortner
authors.affiliation: Department of Cardiology B, Aarhus University Hospital Skejby, Aarhus N, Denmark.
authors.forename: Bjarne L
authors.initials: BL
authors.lastname: Nørgaard
authors.affiliation: Department of Cardiology, University of Erlangen, Erlangen, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Achenbach
authors.affiliation: Department of Medical Imaging, St. Paul's Hospital, Vancouver, BC, Canada.
authors.forename: Jonathon
authors.initials: J
authors.lastname: Leipsic
authors.affiliation: Division of Cardiology, Department of Medicine, Glostrup University Hospital, Glostrup, Denmark.
authors.forename: Jawdat
authors.initials: J
authors.lastname: Abdulla
mesh_terms: D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D004562:Electrocardiography; D005080:Exercise Test; D006801:Humans; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed
keywords: Coronary computed tomography angiography; Exercise electrocardiography; Meta-analysis; Non-invasive diagnostic testing; single-photon emission computed tomography