Electron-Beam Computed Tomography in the Diagnosis of Coronary Artery Disease
Open Access
- 26 March 2001
- journal article
- research article
- Published by American Medical Association (AMA) in Archives of Internal Medicine
- Vol. 161 (6), 833-838
- https://doi.org/10.1001/archinte.161.6.833
Abstract
Background Electron-beam computed tomography (EBCT) is a new, noninvasive method of detecting coronary artery calcification that is being increasingly advocated as a diagnostic test for coronary artery disease (CAD). Before its clinical use is justified, however, the overall accuracy of EBCT must be better defined. Objective To estimate the accuracy of EBCT in diagnosing obstructive CAD. Data Sources English-language studies from January 1, 1979, through Feburary 29, 2000, were retrieved using MEDLINE and Current Contents databases, bibliographies, and expert consultation. Study Selection We included a study if it (1) used EBCT as a diagnostic test; (2) reported cases in absolute numbers of true-positive, false-positive, true-negative, and false-negative results; and (3) used coronary angiography as the reference standard for diagnosing obstructive CAD (defined as ≥50% diameter stenosis). Data Extraction Data were extracted from the included articles by 2 independent reviewers. Data Synthesis Weighted pooled analysis and summary receiver operating characteristic (ROC) curve analysis were used to determine sensitivity and specificity rates. Results from 9 studies with 1662 subjects were included. Pooled sensitivity for EBCT was 92.3% (95% confidence interval [CI], 90.7%-94.0%) and pooled specificity was 51.2% (95% CI, 47.5%-54.9%). Maximum joint sensitivity and specificity for EBCT from its summary ROC curve was 75%. As the threshold for defining an abnormal test varied, sensitivity and specificity changed. For a threshold that resulted in a sensitivity of 90%, specificity was 54%; when sensitivity was 80%, specificity rose to 71%. Conclusion The performance of EBCT as a diagnostic test for obstructive CAD is reasonable based on sensitivity and specificity rates from its summary ROC curve.Keywords
This publication has 19 references indexed in Scilit:
- Coronary calcification by electron beam computed tomography and obstructive coronary artery disease: a model for costs and effectiveness of diagnosis as compared with conventional cardiac testing methodsJournal of the American College of Cardiology, 1999
- Self-Referral of Patients for Electron-Beam Computed Tomography to Screen for Coronary Artery DiseaseNew England Journal of Medicine, 1998
- Noninvasive Detection of AtherosclerosisNew England Journal of Medicine, 1998
- Electron-Beam Computed Tomography, Coronary Artery Calcium, and Evaluation of Patients with Coronary Artery DiseaseAnnals of Internal Medicine, 1998
- Coronary calcium and standard risk factors in symptomatic patients referred for coronary angiographyAmerican Heart Journal, 1998
- Quantification of coronary artery calcium by electron beam computed tomography for determination of severity of angiographic coronary artery disease in younger patientsJournal of the American College of Cardiology, 1995
- Guidelines for Meta-analyses Evaluating Diagnostic TestsAnnals of Internal Medicine, 1994
- Coronary artery calcification detected with ultrafast CT as an indication of coronary artery disease.Radiology, 1992
- Quantification of coronary artery calcium using ultrafast computed tomographyJournal of the American College of Cardiology, 1990
- Significance of calcification of the coronary arteriesThe American Journal of Cardiology, 1970