title: Negative predictive value of stress myocardial perfusion imaging and coronary computed tomography angiography: A meta-analysis.
abstract: Comparing the prognostic value of a negative finding by stress single-photon emission computed tomography myocardial perfusion imaging (MPI) and coronary computed tomography angiography (CCTA) may be useful to evaluate how better identify low-risk patients. We performed a meta-analysis to compare the long-term negative predictive value (NPV) of normal stress MPI and normal CCTA in subjects with suspected coronary artery disease (CAD).
  
  
  
  Studies published between January 2000 and November 2016 were identified by database search. We included MPI and CCTA studies that followed-up ≥100 subjects for ≥5 years and providing data on clinical outcome for patients with negative tests. Summary risk estimates for normal perfusion at MPI or <50% coronary stenosis at CCTA were derived in random effect regression analysis, and causes of heterogeneity were determined in meta-regression analysis. We identified 12 eligible articles (6 MPI and 6 CCTA) including 33,129 patients (26,757 in MPI and 6372 in CCTA studies) with suspected CAD. The pooled annualized event rate (AER) for occurrence of hard events (death and nonfatal myocardial infarction) was 1.06 (95% confidence interval, CI 0.49-1.64) in MPI and 0.61 (95% CI 0.35-0.86) in CCTA studies. The pooled NPV was 91% (95% CI 86-96) in MPI and 96 (95% CI 95-98) in CCTA studies. The summary rates between MPI and CCTA were not statistically different. At meta-regression analysis, no significant association between AER and clinical and demographical variables considered was found for overall studies.
  
  
  
  Stress MPI and CCTA have a similar ability to identify low-risk patients with suspected CAD.
authors.affiliation: Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Green
authors.affiliation: Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Cantoni
authors.affiliation: Department of Translational Medical Sciences, University Federico II, Naples, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Petretta
authors.affiliation: Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy.
authors.forename: Wanda
authors.initials: W
authors.lastname: Acampa
authors.affiliation: Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy.
authors.forename: Mariarosaria
authors.initials: M
authors.lastname: Panico
authors.affiliation: Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Buongiorno
authors.affiliation: Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Punzo
authors.affiliation: IRCCS SDN, Naples, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Salvatore
authors.affiliation: Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy. cuocolo@unina.it.
authors.forename: Alberto
authors.initials: A
authors.lastname: Cuocolo
mesh_terms: D000328:Adult; D000368:Aged; D000072226:Computed Tomography Angiography / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis
keywords: Myocardial perfusion imaging; SPECT; computed tomography (CT); coronary anatomy; prognosis