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Electron-Beam Computed Tomography in the Diagnosis of Coronary Artery Disease
A Meta-analysis
Brahmajee K. Nallamothu, MD, MPH;
Sanjay Saint, MD, MPH;
Lawrence F. Bielak, DDS, MPH;
Seema S. Sonnad, PhD;
Patricia A. Peyser, PhD;
Melvyn Rubenfire, MD;
A. Mark Fendrick, MD
Arch Intern Med. 2001;161:833-838.
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.
From the Divisions of General Medicine (Drs Nallamothu, Saint, and
Fendrick) and Cardiology (Drs Nallamothu and Rubenfire), Department of Internal
Medicine, the Department of Surgery (Dr Sonnad), and the Consortium for Health
Outcomes, Innovation, and Cost-Effectiveness Studies (Drs Sonnad and Fendrick),
University of Michigan Medical School, and the Department of Epidemiology,
University of Michigan School of Public Health (Drs Bielak and Peyser), Ann
Arbor.
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