Abstract 362: Diagnostic Value of Non-invasive Computed Tomography Perfusion Imaging for Assessing Hemodynamically Significant Native Coronary Artery Lesion: A Meta-analysis

Abstract

Background: Traditionally, hemodynamic significance of a native coronary artery lesion is determined by invasive coronary angiography and fractional flow reserve. Computed tomography perfusion imaging (CTP) is a novel non-invasive method for determining hemodynamic significance of a coronary artery lesion. The objective of our meta-analysis is to determine the diagnostic performance of CTP with and without computed tomography angiography (CTA) in assessment of hemodynamically significant coronary artery lesions in comparison to invasive angiography. Methods: PubMed was searched through December 2014. Nine original studies were found evaluating the diagnostic performance of CTP with and without CTA to invasive coronary angiography in evaluation of hemodynamic significance of coronary lesions (n=951). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and positive and negative likelihood ratios (LR+ and LR- respectively) were calculated using hierarchical summary receiver operating curves and compared with bivariate random-effects model to accommodate for heterogeneity due to study design, population and diagnostic tests. Results: Total of 951 coronary vessels were evaluated for hemodynamically significant lesions. The sensitivity, specificity, PPV, NPV, LR+ and LR- values for CTP with CTA to diagnose hemodynamically significant coronary artery lesions were 83%, 91.7%, 86.4%, 89.4%, 9.94, and 0.19 respectively. The sensitivity, specificity, PPV, NPV, LR+ and LR- values for CTP alone were 82.9%, 84%. 76.1%, 88.9%, 5.18, and 0.20 respectively. The sensitivity, specificity, PPV, NPV, LR+ and LR- values for CTA alone were 89%, 72%, 64.2%, 92.1%, 3.18, and 0.15 respectively (Figure). Conclusion: The results of our meta-analysis assessing diagnostic value of CTP with or without CTA suggest that adding CTA to CTP significantly improves diagnostic performance of hemodynamic significance of coronary artery lesions compared to CTP alone. CTA with CTP is closely comparable with invasive angiography in assessing hemodynamic significance of coronary artery lesions in patients with stable coronary artery disease.