Comparison of the prognostic value of negative non-invasive cardiac investigations in patients with suspected or known coronary artery disease-a meta-analysis.
OBJECTIVE
To compare the prognostic value of negative non-invasive cardiac investigations (coronary computed tomographic angiography [CCTA], cardiovascular magnetic resonance [CMR], exercise electrocardiographic testing [EET], positron emission tomography [PET], stress-echocardiography [SE], and single-photon emission tomography [SPECT]) in patients with suspected or known coronary artery disease (CAD) and to explore the effect of adjustment for population event risk and presence of CAD.


RESULTS
MEDLINE/PubMed database, EMBASE and Cochrane Library were searched from January-1990 to April-2015 for studies reporting annual event rates (AER) of myocardial infarction (MI) and cardiac death. Pooled estimates of AERs were calculated using a DerSimonian and Laird random-effects model. Multivariable linear meta-regression analysis was performed to compare the AER after a negative test result between modalities and to adjust for population event risk and proportion of patients with CAD. In 165 studies (122,721 patients), pooled AERs after negative test results differed significantly between modalities ranging from 0.32% for CCTA to 1.66% for SE, P < 0.001. However, the AER after a negative test result was positively correlated (r = 0.726, P < 0.001) with population event risk. Adjusting for population event risk and proportion of patients with CAD resulted in more similar event rates after a negative test result.


CONCLUSIONS
This meta-analysis is the first study comparing the prognostic value of all available non-invasive cardiac investigations. Outcome differences between modalities after a negative test result are profoundly influenced by large variations in population event risk and a negative test result for all modalities conveys an excellent prognosis for patients with suspected or known CAD.
Department of Cardiology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands.|Cardiovascular Research Institute Maastricht (CARIM).
Martijn W
MW
Smulders
Department of Cardiology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
Caroline
C
Jaarsma
Epidemiology, Maastricht University Medical Center, Maastricht, The Netherlands.
Patricia J
PJ
Nelemans
Department of Cardiology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands.|Cardiovascular Research Institute Maastricht (CARIM).|Radiology, Maastricht University Medical Center, Maastricht, The Netherlands.
Sebastiaan C A M
SCAM
Bekkers
Cardiovascular Research Institute Maastricht (CARIM).|Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.|Department of Nuclear Medicine, University Hospital Aachen, Aachen, Germany.
Jan
J
Bucerius
Department of Radiology, Utrecht University Medical Center, Utrecht, The Netherlands.
Tim
T
Leiner
Department of Cardiology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands.|Cardiovascular Research Institute Maastricht (CARIM).
Harry J G M
HJGM
Crijns
Cardiovascular Research Institute Maastricht (CARIM).|Radiology, Maastricht University Medical Center, Maastricht, The Netherlands.
Joachim E
JE
Wildberger
Department of Cardiology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands.|Cardiovascular Research Institute Maastricht (CARIM).|Radiology, Maastricht University Medical Center, Maastricht, The Netherlands.
Simon
S
Schalla
D000368:Aged; D058070:Asymptomatic Diseases; D057791:Cardiac Imaging Techniques / Q000379:methods*; D000072226:Computed Tomography Angiography / Q000379:methods; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality; D018450:Disease Progression; D025401:Echocardiography, Stress / Q000379:methods; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality; D049268:Positron-Emission Tomography / Q000379:methods; D011379:Prognosis; D012720:Severity of Illness Index; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods
coronary artery disease ; non-invasive cardiac investigations; prognosis 