Department of Medical Statistics, Informatics and Documentation, University Hospital of Friedrich-Schiller University Jena, Jena, Germany.
Eur Radiol. 2011 Sep;21(9):1904-13. doi: 10.1007/s00330-011-2142-2. Epub 2011 May 20.
To evaluate the impact of coronary artery disease (CAD) prevalence on the predictive values of coronary CT angiography.
We performed a meta-regression based on a generalised linear mixed model using the binomial distribution and a logit link to analyse the influence of the prevalence of CAD in published studies on the per-patient negative and positive predictive values of CT in comparison to conventional coronary angiography as the reference standard. A prevalence range in which the negative predictive value was higher than 90%, while at the same time the positive predictive value was higher than 70% was considered appropriate.
The summary negative and positive predictive values of coronary CT angiography were 93.7% (95% confidence interval [CI] 92.8-94.5%) and 87.5% (95% CI, 86.5-88.5%), respectively. With 95% confidence, negative and positive predictive values higher than 90% and 70% were available with CT for a CAD prevalence of 18-63%. CT systems with >16 detector rows met these requirements for the positive (P < 0.01) and negative (P < 0.05) predictive values in a significantly broader range than systems with ≤16 detector rows.
It is reasonable to perform coronary CT angiography as a rule-out test in patients with a low-to-intermediate likelihood of disease.
评估冠状动脉疾病 (CAD) 患病率对冠状动脉 CT 血管造影预测值的影响。
我们使用基于广义线性混合模型的荟萃回归，采用二项式分布和对数链接，分析发表研究中 CAD 患病率对 CT 每例患者阴性和阳性预测值的影响，以传统冠状动脉造影作为参考标准。我们认为，当阴性预测值高于 90%，同时阳性预测值高于 70%的患病率范围是合适的。
冠状动脉 CT 血管造影的汇总阴性和阳性预测值分别为 93.7%（95%置信区间 [CI] 92.8-94.5%）和 87.5%（95% CI，86.5-88.5%）。在 95%置信区间内，CAD 患病率为 18-63%时，CT 的阴性和阳性预测值均高于 90%和 70%。阳性预测值（P<0.01）和阴性预测值（P<0.05）方面，具有 >16 个探测器排的 CT 系统在比具有 ≤16 个探测器排的系统更广泛的范围内满足这些要求。
对于疾病低至中度可能性的患者，进行冠状动脉 CT 血管造影作为排除检查是合理的。
