Detection of non-ST-elevation myocardial infarction and unstable angina in the acute setting: meta-analysis of diagnostic performance of multi-detector computed tomographic angiography

doi:10.1186/1471-2261-7-39

BMC Cardiovascular Disorders

Volume 7

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Vanhoenacker PK
Decramer I
Bladt O
Sarno G
Bevernage C
Wijns W

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Decramer I
Bladt O
Sarno G
Bevernage C
Wijns W
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Research article

Detection of non-ST-elevation myocardial infarction and unstable angina in the acute setting: meta-analysis of diagnostic performance of multi-detector computed tomographic angiography

Piet K Vanhoenacker¹^* , Isabel Decramer¹^,2^* , Olivier Bladt¹ , Giovanna Sarno² , Charlotte Bevernage¹ and William Wijns²

¹Department of Radiology and Medical Imaging, Onze Lieve Vrouw Ziekenhuis, Aalst, Belgium

²Cardiovascular Center Aalst, Aalst, Belgium

author email corresponding author email* Contributed equally

BMC Cardiovascular Disorders 2007, 7:39doi:10.1186/1471-2261-7-39


Published:	19 December 2007

Abstract

Background

Multi-detector computed tomography angiography (MDCTA) has been increasingly used in the evaluation of the coronary arteries. The purpose of this study was to review the literature on the diagnostic performance of MDCTA in the acute setting, for the detection of non-ST-elevation myocardial infarction (NSTEMI) and unstable angina pectoris (UAP).

Methods

A Pubmed and manual search of the literature published between January 2000 and June 2007 was performed. Studies were included that compared MDCTA with clinical outcome and/or CA in patients with acute chest pain, presenting at the emergency department. More specifically, studies that only included patients with initially negative cardiac enzymes suspected of having NSTEMI or UAP were included. Summary estimates of diagnostic odds ratio (DOR), sensitivity and specificity, negative (NLR) and positive likelihood ratio (PLR) were calculated on a patient basis. Random-effects models and summary receiver operating curve (SROC) analysis were used to assess the diagnostic performance of MDCTA with 4 detectors or more. The proportion of non assessable scans (NAP) on MDCTA was also evaluated. In addition, the influence of study characteristics of each study on diagnostic performance and NAP was investigated with multivariable logistic regression.

Results

Nine studies totalling 566 patients, were included in the meta-analysis: one randomised trial and eight prospective cohort studies. Five studies on 64-detector MDCTA and 4 studies on MDCTA with less than 64 detectors were included (32 detectors n = 1, 16 detectors n = 2, 16 and 4 detectors n = 1). Pooled DOR was 131.81 (95%CI, 50.90–341.31). The pooled sensitivity and specificity were 0.95 (95%CI, 0.90–0.98) and 0.90 (95%CI, 0.87–0.93). The pooled NLR and PLR were 0.12 (95%CI, 0.06–0.21) and 8,60 (95%CI, 5.03–14,69).

The results of the logistic regressions showed that none of the investigated variables had influence on the diagnostic performance or NAP

Conclusion

MDCTA of the coronary arteries performs good to excellent in the diagnosis of coronary artery disease in the acute setting and it can be used for early exclusion of NSTEMI or UAP in patients in the emergency department.