Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Quebec City, Canada.
Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne, Saint-Etienne, France.
J Thromb Haemost. 2018 Jun;16(6):1107-1120. doi: 10.1111/jth.14021. Epub 2018 May 17.
Essentials Computed tomographic pulmonary angiography (CTPA) is used to exclude pulmonary embolism. This meta-analysis explores the occurrence of venous thromboembolic events (VTE) after a CTPA. Occurrence of VTE after a negative CTPA is ˜8% in study subgroups with a prevalence of PE ≥ 40%. CTPA may be insufficient to safely rule out VTE as a stand-alone diagnostic test for this subgroup.
Background Outcome studies have reported the safety of computed tomographic pulmonary angiography (CTPA) as a stand-alone imaging technique to rule out pulmonary embolism (PE). Whether this can be applied to all clinical probabilities remains controversial. Objectives We performed a meta-analysis to determine the proportion of patients with venous thromboembolic events (VTE) despite a negative CTPA according to pretest PE prevalence. Methods We searched MEDLINE, EMBASE and the Cochrane Library (January 1990 to May 2017) for outcome studies recruiting patients with suspected PE using CTPA as a diagnostic strategy. The primary outcome was the cumulative occurrence of VTE at 3 months following a negative CTPA. Results Twenty-two different studies were identified. VTE was confirmed in 2.4% of patients (95% CI, 1.3-3.8%) either at the time of the index event or in the 3 months follow-up. Subgroup analyses suggested that the cumulative occurrence of VTE was related to pretest prevalence of PE, as VTE occurred in 1.8% (95% CI, 0.5-3.7%), 1.4% (95% CI, 0.7-2.3%), 1.0% (95% CI, 0.5-1.8%) and 8.1% (95% CI, 3.5-14.5%) of subgroups of patients with a PE prevalence < 20%, 20-29%, 30-39% and ≥ 40%, respectively. This was further confirmed using meta-regression analysis. Conclusions The negative predictive value of CTPA for VTE varies according to pretest prevalence of PE, and is likely to be insufficient to safely rule out VTE as a stand-alone diagnostic test amongst patients at the highest pretest probability of VTE. Prospective studies are required to validate the appropriate diagnostic algorithm for this subgroup of patients.
计算机断层肺动脉造影术（CTPA）被用于排除肺栓塞。本荟萃分析旨在探讨 CTPA 后静脉血栓栓塞事件（VTE）的发生情况。在 PE 患病率≥40%的研究亚组中，阴性 CTPA 后 VTE 的发生率约为 8%。对于 VTE 患病率较高的患者，CTPA 可能不足以作为单独的诊断检测手段来安全排除 VTE。
背景：已有研究报道，计算机断层肺动脉造影术（CTPA）作为一种排除肺栓塞（PE）的独立成像技术是安全的。但这是否适用于所有临床可能性仍存在争议。
我们进行了一项荟萃分析，以确定根据 PE 患病率，在阴性 CTPA 后仍存在 VTE 的患者比例。
共确定了 22 项不同的研究。在索引事件时或在 3 个月的随访中，有 2.4%（95%CI，1.3-3.8%）的患者确诊为 VTE。亚组分析表明，VTE 的累积发生率与 PE 的患病率有关，PE 患病率<20%、20-29%、30-39%和≥40%的亚组患者中 VTE 的发生率分别为 1.8%（95%CI，0.5-3.7%）、1.4%（95%CI，0.7-2.3%）、1.0%（95%CI，0.5-1.8%）和 8.1%（95%CI，3.5-14.5%）。这一点通过荟萃回归分析进一步得到证实。
CTPA 对 VTE 的阴性预测值随 PE 的患病率而变化，在 VTE 患病率最高的患者中，可能不足以安全排除 VTE 作为单独的诊断检测手段。需要前瞻性研究来验证该亚组患者的适当诊断算法。
