title: Prognostic value of cardiac computed tomography angiography in patients with suspected coronary artery disease: a meta-analysis.
abstract: OBJECTIVE
  The diagnostic accuracy of cardiac computed tomography angiography (CCTA) is well reported. The prognostic value of CCTA has been described in several studies, but many of these were underpowered and an update of the meta-analysis is necessary to increase the power to predict rare events. The purpose of this study was to perform a meta-analysis of the ability of CCTA to predict future cardiovascular events.
  
  
  METHODS
  We searched multiple databases for longitudinal studies of CCTA with a follow-up of at least 12 months of symptomatic patients with suspected coronary artery disease (CAD) reporting major adverse cardiovascular events (MACE), death, myocardial infarction and revascularization. Summary test parameters and receiver-operating characteristic curves were calculated.
  
  
  RESULTS
  Eighteen studies evaluated 29,243 patients with a median follow-up of 25 months. For MACE in patients with negative findings on CCTA, there was a pooled negative likelihood ratio (LR) of 0.01 [95% confidence interval (CI) 0.00-0.08], a positive LR of 1.72 (95% CI 1.54-1.91), a sensitivity of 1.00 (95% CI 0.97-1.00), a specificity of 0.42 (95% CI 0.36-0.48) and a diagnostic odds ratio of 159.07 (95% CI 22.20-1,139.80). The weighted average annualized MACE rate for positive versus negative CCTA findings was 3.49 versus 0.21%. Stratifying by no CAD, nonobstructive CAD or obstructive CAD, there were incrementally increasing adverse events.
  
  
  CONCLUSIONS
  Adverse cardiovascular events among patients with normal findings on CCTA are rare. There are incrementally increasing future MACE with increasing CAD by CCTA.
authors.affiliation: Department of Radiology, BenQ Medical Center, Nanjing Medical University, Nanjing, PR China.
authors.forename: Binghu
authors.initials: B
authors.lastname: Jiang
authors.forename: Jichen
authors.initials: J
authors.lastname: Wang
authors.forename: Xianjun
authors.initials: X
authors.lastname: Lv
authors.forename: Wei
authors.initials: W
authors.lastname: Cai
mesh_terms: D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D006801:Humans; D011379:Prognosis; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed