Coronary disease & ACSMeta-analysis
Diagnostic yield of second-line functional imaging after an abnormal coronary computed tomography angiography: an individual patient-data meta-analysis
- individual patient-data meta-analysis of seven prospective diagnostic studies
Authors' conclusion
Second-line functional imaging after an abnormal CCTA enables identification of patients with anatomically severe CAD. In contrast, moderate stenoses (<70% DS) with FFR ≤0.80 do not consistently result in myocardial ischaemia detectable by functional imaging tests. Substantial diagnostic accuracy differences were found between non-invasive diagnostic test which need further investigation.
Study context
- Population
- Patients with abnormal coronary computed tomography angiography (CCTA) [≥50% diameter stenosis (DS)] who underwent second-line functional imaging tests followed by invasive angiography with fractional flow reserve (FFR) and quantitative coronary angiography (QCA)patients (mean age 62 ± 8.1 years, 67% male), 1906 functional imaging tests
- Participants
- 1,410 patients
- Comparison
- Second-line functional imaging against invasive FFR and QCA reference standards
- Second-line functional imagingn = 1,906
Pooled result
As reported in the abstract
Functional imaging tests with haemodynamically obstructive coronary artery disease (CAD)
904/1906 (47.2%)
Further pooled results
| Outcome | Values |
|---|---|
| Diagnostic performance for haemodynamically obstructive CAD | Second-line functional imaging Pooled sensitivity 63% · Pooled specificity 84% |
| Diagnostic performance for anatomically severe CAD | Second-line functional imaging Pooled sensitivity 81% · Pooled specificity 77% |
Anatomically severe CAD (≥70% DS by QCA)
- Functional imaging tests with anatomically severe CAD
- 504/1906 (26.3%)
- Pooled and per test
Abnormal functional imaging tests
- Abnormal functional imaging tests
- 730/1906 (38.3%)
Diagnostic performance by sex and age
- Findings were generally stable across sex and age
Diagnostic performance by test type
- More advanced second-line functional imaging tests showed higher sensitivities, but lower specificities compared to less advanced techniques
Original publication
Summarised from the published abstract; every number is checked against it