The diagnosis value of computed tomography coronary angiography versus 99mTc-MIBI myocardial perfusion imaging in patients undergoing invasive coronary angiography: A meta-analysis

Objectives A meta-analysis was performed of the published literature to compare the sensitivity and specificity of CTA versus MPI for≥50% stenosis of any coronary artery or myocardial ischemia in patients with known or suspected coronary disease.

Methods According to the inclusion and exclusion criteria, we searched PUBMED/MEDLINE and some big Chinese databases such as China Academic Journal Network Publishing Database (CAJD) for relevant original articles that evaluated the sensitivity and specificity of CTA and MPI with invasive coronary angiography as the reference standard and reported sufficient data to calculate patient-level true and false positive and negative. The qualities of the studies were evaluated with QUADAS quality assessment tool. Based on data from included studies, a software, meta-disc, was used to obtain the pooled sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratio(PLR),and negative likelihood ratio(NLR). Summary receiver-operating characteristic (SROC) curves were also constructed to assess diagnostic value of CTA and 99mTc -MIBI SPECT MPI in detecting Coronary Artery Disease.

Results We identified 10 studies, all of them are retrospective, and 486 patients are included. On a per-patient basis, the meta-analysis demonstrated a significantly higher pooled mean sensitivity with CTA (91% [95% Confidence Interval, 87% to 94%]) compared with MPI (76% [95% confidence interval,71% to81%]) (P=0.0003). No significant difference in specificity was observed between CTA (86% [95% CI, 80% to 90.4) and MPI (71% [95% CI, 64% to 78%]) (P=0.0876). The Q * and SROC area under curve for CTA and SPECT are 0.8542 and 0.7422, 0.9207 and 0.8072, respectively.

Conclusions In the meta-analysis, CTA demonstrated a higher sensitivity for coronary artery disease than SPECT MPI. No difference in specificity was detected in the pooled analysis of CTA and SPECT MPI.