Asunto(s)
Anomalías de los Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/diagnóstico por imagen , Mortalidad Hospitalaria , Infarto del Miocardio con Elevación del ST/terapia , Choque Cardiogénico/epidemiología , Enfermedades Vasculares/congénito , Adulto , Anciano , Anciano de 80 o más Años , Circulación Asistida/estadística & datos numéricos , Angiografía Coronaria , Puente de Arteria Coronaria/estadística & datos numéricos , Anomalías de los Vasos Coronarios/complicaciones , Bases de Datos Factuales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Intervención Coronaria Percutánea/estadística & datos numéricos , Infarto del Miocardio con Elevación del ST/etiología , Choque Cardiogénico/etiología , Choque Cardiogénico/terapia , Enfermedades Vasculares/complicaciones , Enfermedades Vasculares/diagnóstico por imagenAsunto(s)
Angiografía Coronaria/tendencias , Mortalidad Hospitalaria , Infarto del Miocardio sin Elevación del ST/terapia , Readmisión del Paciente/estadística & datos numéricos , Anciano , Angiografía Coronaria/estadística & datos numéricos , Bases de Datos Factuales , Manejo de la Enfermedad , Intervención Médica Temprana , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio sin Elevación del ST/diagnóstico por imagen , Factores de TiempoRESUMEN
PURPOSE: In aortic stenosis patients referred for surgical and transcatheter aortic valve replacement (AVR), the evidence of diagnostic accuracy of coronary computed tomography angiography (CCTA) has been limited. The objective of this study was to investigate the diagnostic accuracy of CCTA for significant coronary artery disease (CAD) in patients referred for AVR using invasive coronary angiography (ICA) as the gold standard. MATERIALS AND METHODS: We searched databases for all diagnostic studies of CCTA in patients referred for AVR, which reported diagnostic testing characteristics on patient-based analysis required to pool summary sensitivity, specificity, positive-likelihood ratio, and negative-likelihood ratio. Significant CAD in both CCTA and ICA was defined by >50% stenosis in any coronary artery, coronary stent, or bypass graft. RESULTS: Thirteen studies evaluated 1498 patients (mean age, 74 y; 47% men; 76% transcatheter AVR). The pooled prevalence of significant stenosis determined by ICA was 43%. Hierarchical summary receiver-operating characteristic analysis demonstrated a summary area under curve of 0.96. The pooled sensitivity, specificity, and positive-likelihood and negative-likelihood ratios of CCTA in identifying significant stenosis determined by ICA were 95%, 79%, 4.48, and 0.06, respectively. In subgroup analysis, the diagnostic profiles of CCTA were comparable between surgical and transcatheter AVR. CONCLUSIONS: Despite the higher prevalence of significant CAD in patients with aortic stenosis than with other valvular heart diseases, our meta-analysis has shown that CCTA has a suitable diagnostic accuracy profile as a gatekeeper test for ICA. Our study illustrates a need for further study of the potential role of CCTA in preoperative planning for AVR.