冠状动脉CT成像评价可疑冠心病患者预后的meta分析

Prognostic value of coronary computed tomography angiography in patients with suspected coronary artery disease:A meta-analysis

目的评价冠状动脉CT成像（CCTA）预测可疑冠心病（CAD）患者预后的价值。方法检索PubMed、EMBASE和CochraneI．ibrary数据库。采用Statall．0分析数据，合并灵敏度、特异度、阳性似然比（＋LR）、阴性似然比（-LR）、诊断比值比（DOR）及其95％可信区间，绘制总受试者工作特征（SROc）曲线。结果共纳入19篇文献，合计38150例可疑冠心病患者，中位随访期25个月。阴性CCTA患者中，主要不良心血管事件（MACE）、死亡、心肌梗塞（MI）和血管再通发生率分别为0．48％、0．34％、0．05％和0．02％；阳性CCTA患者中，相应事件发生率分别为7．68％、1．59％、0．89％和1．39％。MACE的合并敏感度、特异度、＋LR、-LR和DOR分别为0．99（95％CI：0．97～1．00）、0．43（95％CI：0．37～0．49）、1．74（95％CI：1．56～1_93）、0．01（95％CI：0．00～0．08）和118．27（95％Cj：20．69～676．06）。结论CCTA时可疑CAD患者具有极好的预后价值，阴性CCTA可基本排除不良心血管事件的发生。

Objective To perform a meta-analysis of the ability of coronary computed tomography angiography （CCTA） and predict future cardiovascular events in patients with suspected coronary artery disease （CAD）. Methods We searched multiple databases for longitudinal studies of CCTA with at least 12 months follow-up of symptomatic pa- tients with CAD reporting major adverse cardiovascular events （MACE）, consisting of death, myocardial infarction （MI）, or revascularization. Summary test parameters （sensitivity, specificity, positive and negative likelihood ratio, diagnostic odds ratio） and receiver-operating characteristic curves were calculated. Results Nineteen studies evaluated 38, 150 patients with a median follow-up of 25 months. The pooled negative likelihood ratio （LR） for MACE in patients with negative findings on CCTA was 0.01 （95% confidence interval （CI） ; 0.00 -0.08） ; positive LR of 1.74 （95% CI： 1.56 1.93）, sensitivity of 0.99 （95% CI： 0. 97 1.00）, specificity of 0.43 （95%CI= 0. 37 -0. 49）, and diagnostic odds ratio （DOR） of 118.27 （950/oo CI= 20.69-676.06）. The weighted average annualized MACE rate for positive versus negative CCTA findings was 3.27% versus 0.23%. Stratifying by no CAD, non-obstructive CAD, or obstructive CAD, there were incrementally increasing adverse events. Conclusion Adverse cardiovascular events among patients with normal findings on CCTA are rare. There are incrementally increasing future MACE with increasing CAD by CCTA.