• von BallmoosMoritz WylerMWHarvard School of Public Health, Children's Hospital Boston, Harvard Medical School, Beth Israel Deaconess Hospital, Massachusetts, USA. wylervonballmoos@gmail.com, Bernhard Haring, Pascal Juillerat, and Hatem Alkadhi.
• Harvard School of Public Health, Children's Hospital Boston, Harvard Medical School, Beth Israel Deaconess Hospital, Massachusetts, USA. wylervonballmoos@gmail.com
• Ann. Intern. Med. 2011 Mar 15; 154 (6): 413420413-20.

BackgroundA new radiation dose-saving technique for noninvasive coronary artery imaging with computed tomography (CT) is available.PurposeTo summarize current evidence about the ability of low-dose coronary CT angiography to rule out coronary artery disease (CAD) in symptomatic adults.Data SourcesOnline databases, including MEDLINE, EMBASE, and the Cochrane Library, from inception through 31 October 2010; abstract databases; gray literature; reference lists of identified articles; and experts. No language restrictions were applied.Study SelectionAll investigators screened and selected studies that compared prospective electrocardiography-gated coronary CT angiography with catheter coronary angiography (the reference standard) in symptomatic patients with suspected CAD.Data ExtractionTwo investigators independently extracted patient and study protocol characteristics and rated methodological quality; differences were resolved by consensus or by a third reader. Multivariate random-effects models were used to obtain pooled estimates.Data Synthesis16 studies, comprising 960 patients, were found (7 studies of single-source, 64-slice CT; 4 of dual-source, 64-slice CT; 2 of single-source, 320-slice CT; 1 dual-source, 128-slice CT; 1 of single-source, 128-slice CT; and 1 of single-source, 256-slice CT). On average, 2.4% of the coronary arterial segments were of nondiagnostic image quality, and 1 or more segments were nondiagnostic in 9.5% of the patients. The patient-level sensitivity and specificity of CT angiography were 1.00 (95% CI, 0.98 to 1.00) and 0.89 (CI, 0.85 to 0.92), respectively. The pooled vessel- and segment-level estimates showed lower sensitivity and higher specificity than the patient-level estimates. Statistically significant heterogeneity was found between studies for vessel- and segment-level estimates, which seemed to be associated with body mass index and prevalence of CAD but not with CT scanner characteristics.LimitationsThe small number of studies, half of which were from a single tertiary center, limits generalizability. The potential harms of the imaging tests were not well-evaluated.ConclusionEarly evidence suggests that low-dose coronary CT angiography matches the sensitivity of catheter-based angiography, has low radiation exposure, and is a potentially valid alternative to catheter angiography for triaging symptomatic patients with a clinical suspicion of CAD.Primary Funding SourceNone.

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