Computed tomography for detecting coronary artery plaques: A meta-analysis

Objectives: CT is a novel noninvasive test for detection and analysis of coronary artery plaques. However, the ability of CT to detect and quantify coronary atherosclerotic plaque in vivo has never been systematically validated. We sought to conduct a meta-analysis to evaluate the accuracy of Computed tomography (CT) in detecting coronary artery plaques. Methods: We systematically searched the literature to identify reports published from 1966 up to January 2011 in Pubmed and EMBASE that described studies comparing CT and intravascular ultrasound (IVUS), the reference standard, in assessing coronary artery plaques. We sought reports that clearly indicated the number of true positive, false positive, false negative and true negative results. Results: We identified 17 reports of studies. On bivariate analysis, for CT diagnosis of any plaques, the mean sensitivity and specificity was 92% (95% confidence interval, 88-95%) and 93% (90-96%), respectively; for diagnosis of calcified plaque, 93% (84-97%) and 98% (96-99%); and for diagnosis of non-calcified plaque (soft or fibrotic), 88% (81-93%) and 92% (89-95%). Covariate analysis yielded a significantly higher sensitivity (95%) and specificity (94%) for CT scanners with more than 16 rows (P< 0.001) than for older-generation scanners (83% and 92%, respectively). Conclusion: CT should be considered the foremost noninvasive alternative to IVUS for detecting coronary artery plaques. Randomized studies at the patient level are needed to address the potential of CT for use in triage for altering management and outcomes in patients with suspected or onset coronary artery disease.