Diagnostic performance of computed tomography angiography in the detection of coronary artery in-stent restenosis: evidence from an updated meta-analysis.

OBJECTIVES

To evaluate the performance of computed tomography angiography (CTA) ≥64 slices for detecting coronary in-stent restenosis (ISR) and determine the influence of separate characteristics on diagnostic accuracy.

METHODS

We searched the PubMed, EMBASE and Cochrane databases for studies of CTA ≥64 slices in diagnosing ISR. We pooled data on bivariate modelling, and subgroup analysis was also performed.

RESULTS

A total of 35 studies involving 4131 stents were included. The pooled positive likelihood ratio (LR) and the negative likelihood ratio (LR) were 14.0 and 0.10, for CTA in diagnosis-significant ISR ≥50%. LR and LR were similar between CTA >64 slices versus 64 slices (both P > 0.99). LR (0.10) was good for ruling out suspected ISR for <3-mm diameter. Time between CTA and stent implantation >6 months did not affect the ability of CTA for the high LR (12.3) and the LR (0.10). Thick-strut stents ≥100 μm or bifurcation stenting demonstrated inferior accuracy, which was unfavourable for stent imaging.

CONCLUSIONS

With the high LR and LR of CTA, patients with ISR may be appropriate for non-invasive angiographic follow-up. However, CTA imaging seems unsuitable for patients with characteristics unfavourable for stent imaging, such as thick-strut stents or bifurcation stenting.

KEY POINTS

• CTA may provide accurate information on characteristics of in-stent restenosis lesions. • Using CTA, ISR patients may be appropriate for non-invasive angiographic follow-up. • Stent diameter and the number of slices do not influence CTA. • CTA seems unsuitable for patients with thick-strut stents or bifurcation stenting.