Diagnostic accuracy of 64-Slice computed tomography angiography in patients with chest pain vs. SPECT in the assessment of significant Coronary Artery Disease: A systematic review and meta-analysis.]

Abstract: The aim of this systematic review and meta-analysis is to investigate the diagnostic accuracy of Computed Tomography Angiography (CTA) in comparison with that of Single-photon emission computed tomography (SPECT) for the diagnosis of Coronary Artery Disease (CAD) in patients with chest pain who have no prior history of cardiovascular diseases Invasive coronary angiography was considered as the reference test. Method: Cochrane, Scopus, Science Direct, Pubmed and Embase databases were searched. Meta-analysis was performed for determination of pooling estimates of sensitivity, specificity and positive and negative likelihood ratios in CTA and SPECT tests. Results: The pooled sensitivity and specificity of CTA were 91% (95% Confidence Interval [CI] 88%-94%) and 87% (95% CI 84%-98%), respectively. The pooled positive and negative likelihood ratios and the area under the Receiver Operating Characteristic (ROC) curve for CTA were 7.93 (95% CI 5.11-12.29), 0.1 (95% CI 0.06-0.17) and 0.96, respectively. The pooled sensitivity and specificity of SPECT were 81% (95% CI 79%-83%) and 74% (95% CI 71%-78%), respectively. The pooled positive and negative likelihood ratio sand the area under the ROC curve for SPECT were 3.03 (95% CI 2.34-3.91), 0.25 (95% CI 0.21-0.30) and 0.86, respectively. Conclusions: According to the results, the diagnostic accuracy of CTA and SPECT tests lie in the excellent and the very good ranges, respectively. CTA is a stronger evidence than SPECT to rule out cardiovascular diseases in patients with low to intermediate risks for CAD who had no prior history of cardiovascular diseases.