TY - JOUR
T1 - Comparison of the prognostic value of negative non-invasive cardiac investigations in patients with suspected or known coronary artery disease-ameta-analysis
AU - Smulders, Martijn W.
AU - Jaarsma, Caroline
AU - Nelemans, Patricia J.
AU - Bekkers, Sebastiaan C. A. M.
AU - Bucerius, Jan
AU - Leiner, Tim
AU - Crijns, Harry J. G. M.
AU - Wildberger, Joachim E.
AU - Schalla, Simon
PY - 2017/9
Y1 - 2017/9
N2 - Aims To compare the prognostic value of negative non-invasive cardiac investigations (coronary computed tomographic angiography [CCTA], cardiovascular magnetic resonance [CMR], exercise electrocardiographic testing [EET], positron emission tomography [PET], stress-echocardiography [SE], and single-photon emission tomography [SPECT]) in patients with suspected or known coronary artery disease (CAD) and to explore the effect of adjustment for population event risk and presence of CAD.Methods and results MEDLINE/PubMed database, EMBASE and Cochrane Library were searched from January-1990 to April-2015 for studies reporting annual event rates (AER) of myocardial infarction (MI) and cardiac death. Pooled estimates of AERs were calculated using a DerSimonian and Laird random-effects model. Multivariable linear meta-regression analysis was performed to compare the AER after a negative test result between modalities and to adjust for population event risk and proportion of patients with CAD. In 165 studies (122,721 patients), pooled AERs after negative test results differed significantly between modalities ranging from 0.32% for CCTA to 1.66% for SE, P <0.001. However, the AER after a negative test result was positively correlated (r = 0.726, P <0.001) with population event risk. Adjusting for population event risk and proportion of patients with CAD resulted in more similar event rates after a negative test result.Conclusion This meta-analysis is the first study comparing the prognostic value of all available non-invasive cardiac investigations. Outcome differences between modalities after a negative test result are profoundly influenced by large variations in population event risk and a negative test result for all modalities conveys an excellent prognosis for patients with suspected or known CAD.
AB - Aims To compare the prognostic value of negative non-invasive cardiac investigations (coronary computed tomographic angiography [CCTA], cardiovascular magnetic resonance [CMR], exercise electrocardiographic testing [EET], positron emission tomography [PET], stress-echocardiography [SE], and single-photon emission tomography [SPECT]) in patients with suspected or known coronary artery disease (CAD) and to explore the effect of adjustment for population event risk and presence of CAD.Methods and results MEDLINE/PubMed database, EMBASE and Cochrane Library were searched from January-1990 to April-2015 for studies reporting annual event rates (AER) of myocardial infarction (MI) and cardiac death. Pooled estimates of AERs were calculated using a DerSimonian and Laird random-effects model. Multivariable linear meta-regression analysis was performed to compare the AER after a negative test result between modalities and to adjust for population event risk and proportion of patients with CAD. In 165 studies (122,721 patients), pooled AERs after negative test results differed significantly between modalities ranging from 0.32% for CCTA to 1.66% for SE, P <0.001. However, the AER after a negative test result was positively correlated (r = 0.726, P <0.001) with population event risk. Adjusting for population event risk and proportion of patients with CAD resulted in more similar event rates after a negative test result.Conclusion This meta-analysis is the first study comparing the prognostic value of all available non-invasive cardiac investigations. Outcome differences between modalities after a negative test result are profoundly influenced by large variations in population event risk and a negative test result for all modalities conveys an excellent prognosis for patients with suspected or known CAD.
KW - coronary artery disease
KW - prognosis
KW - non-invasive cardiac investigations
KW - COMPUTED-TOMOGRAPHY ANGIOGRAPHY
KW - FRACTIONAL FLOW RESERVE
KW - EXERCISE ECHOCARDIOGRAPHY
KW - CLINICAL-VARIABLES
KW - CT ANGIOGRAPHY
KW - HEART-DISEASE
KW - METAANALYSIS
KW - PERFUSION
KW - RADIATION
KW - EXPOSURE
U2 - 10.1093/ehjci/jex014
DO - 10.1093/ehjci/jex014
M3 - Article
C2 - 28329376
SN - 2047-2404
VL - 18
SP - 980
EP - 987
JO - European Heart Journal Cardiovascular Imaging
JF - European Heart Journal Cardiovascular Imaging
IS - 9
ER -