• G Mowatt, J A Cook, G S Hillis, S Walker, C Fraser, X Jia, and N Waugh.
• Health Services Research Unit, Institute of Applied Health Sciences, College of LifeSciences and Medicine, University of Aberdeen, Aberdeen, UK. g.mowatt@abdn.ac.uk
• Heart. 2008 Nov 1;94(11):1386-93.

ContextCoronary artery disease (CAD) is a major cause of mortality and ill health.ObjectiveTo assess whether 64-slice CT angiography might replace some coronary angiography (CA) for diagnosis and assessment of CAD.Data SourcesElectronic databases, conference proceedings and reference lists of included studies.Study SelectionEligible studies compared 64-slice CT with a reference standard of CA in adults with suspected/known CAD, reporting sensitivity and specificity or true and false positives and negatives.Data ExtractionTwo reviewers independently extracted data from included studies.ResultsForty studies were included; 28 provided sufficient data for inclusion in the meta-analyses, all using a cut off point of >/=50% stenosis to define significant CAD. In patient-based detection (n = 1286) 64-slice CT pooled sensitivity was 99% (95% credible interval (CrI) 97% to 99%), specificity 89% (95% CrI 83% to 94%), median positive predictive value (PPV) across studies 93% (range 64-100%) and negative predictive value (NPV) 100% (range 86-100%). In segment-based detection (n = 14 199) 64-slice CT pooled sensitivity was 90% (95% CrI 85% to 94%), specificity 97% (95% CrI 95% to 98%), median PPV across studies 76% (range 44-93%) and NPV 99% (range 95-100%).Conclusions64-Slice CT is highly sensitive for patient-based detection of CAD and has high NPV. An ability to rule out significant CAD means that it may have a role in the assessment of chest pain, particularly when the diagnosis remains uncertain despite clinical evaluation and simple non-invasive testing.

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