Accuracy and Heterogeneity of Stress Imaging for Detecting Coronary Artery Disease: A Systematic Review and Meta-Analysis Using HSROC Methods in 23,051 Patients.
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 23,051
- 试验地点
- 1
- 主要终点
- Diagnostic accuracy
研究概览
简要总结
Background: Detection of coronary artery disease (CAD) is important due to its high prevalence and its medical and economic implications. Purpose: A systematic review of the diagnostic performance of stress echocardiography (Echo), SPECT, cardiac magnetic resonance (CMR), CT Perfusion (CTP) and PET versus invasive coronary angiography (ICA) or fractional flow reserve (FFR) using hierarchical summary ROC (HSROC) methods. Data Sources: MEDLINE, EMBASE and SCOPUS for literature published in English or Spanish from January 1970 to December 2015. Study Selection: For inclusion, studies had to meet the Cochrane guidelines, had to evaluate the sensitivity and specificity methods, and use ICA and/or FFR. Only those studies with STARD methodology ≥60% were included. Data Extraction: Ten investigators extracted patient and study characteristics and 4 resolved any disagreements.
详细描述
Review question: What non-invasive cardiovascular imaging tests (SPECT, Stress Echo [SE], Cardiovascular Magnetic Resonance [CMR], CT Perfusion [CTP] and PET myocardial perfusion) have the best diagnostic accuracy to detect obstructive coronary artery disease using four different cutoffs, two anatomic (invasive coronary angiography) and two functional (invasive fractional flow reserve)? Which non-invasive cardiovascular imaging tests (SPECT, Stress Echo, CMR, CTP and PET myocardial perfusion) have the least bias and heterogeneity in their published data?
Searches: Search in MEDLINE, EMBASE and SCOPUS databases for the literature published in English or Spanish from January 1970 to December 2015 of all prospective and retrospective studies performed with Stress Echo, SPECT, PET, CMR and CTP in patients with suspicion or known CAD compared against the reference standard of ICA (two cutoffs: lesions >50% and >70%) and/or invasive FFR (two cutoffs: <0.80 and <0.75).
Condition being studied: Obstructive coronary artery disease. Non-invasive imaging modalities (SPECT, Stress Echo, CMR, CTP and PET) to evaluate myocardial perfusion as indicative of obstructive coronary artery disease.
Intervention: There was no intervention or exposure, since it was an evaluation of diagnostic accuracy of worldwide current non-invasive cardiovascular imaging modalities compared to the accepted standard of reference.
Comparator: No control group used.
研究设计
- 研究类型
- Observational
- 观察模型
- Other
- 时间视角
- Other
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •All studies (prospective, retrospective and even case series) that included patients of any age and gender with known or suspected coronary artery disease and evaluated the sensitivity and specificity of SE, SPECT, CMR, CTP and PET compared with ICA and/or FFR, and to that met the Cochrane guidelines including a score of >60% with STARD methodology.
排除标准
- •Studies that included patients with known previous myocardial infarction, previous PCI with or without stent implantation, previous cardiac bypass surgery, heart transplantation, and the absence of invasive coronary angiography as a gold standard.
结局指标
主要结局
Diagnostic accuracy
时间窗: Period comprise between 1970 up to the end of 2015.
To introduce scientifically strong evidence-based concepts about the greater diagnostic accuracy of newer and less widely used non-invasive imaging modalities, CMR, CTP and PET, and to emphasize that some of them are even more harmless than the older and more commonly used methods such as SPECT and Stress. Echo.
次要结局
- Modification of the concept that the newer non-invasive imaging modalities are not far more expensive than the older ones.(Period comprise between 1970 up to the end of 2015.)
- Change the current worldwide idea(Period comprise between 1970 up to the end of 2015.)
研究者
Lilia M. Sierra-Galan, MD, MCvT, FACC, FSCCT
Lilia M. Sierra-Galan, MD, MCvT, FACC, FSCCT
American British Cowdray Medical Center