经导管主动脉瓣植入术患者中用于评估阻塞性冠状动脉疾病的冠状动脉计算机断层血管造影的诊断准确性：系统评价和荟萃分析。

OBJECTIVE: To evaluate the diagnostic accuracy of coronary computed tomography angiography (CCTA) for the evaluation of obstructive coronary artery disease (CAD) in patients referred for transcatheter aortic valve implantation (TAVI). METHODS: EMBASE, PubMed/MEDLINE, and CENTRAL were searched for studies reporting accuracy of CCTA for the evaluation of obstructive CAD compared with invasive coronary angiography (ICA) as the reference standard. QUADAS-2 tool was used to assess the risk of bias. A bivariate random effects model was used to analyze, pool, and plot the diagnostic performance measurements across studies. Pooled sensitivity, specificity, positive ( + LR) and negative (-LR) likelihood ratio, diagnostic odds ratio (DOR), and hierarchical summary ROC curve (HSROC) were evaluated. Prospero registration number: CRD42021252527. RESULTS: Fourteen studies (2533 patients) were included. In the intention-to-diagnose patient-level analysis, sensitivity and specificity for CCTA were 97% (95% CI: 94-98%) and 68% (95% CI: 56-68%), respectively, and + LR and -LR were 3.0 (95% CI: 2.1-4.3) and 0.05 (95% CI: 0.03 - 0.09), with DOR equal to 60 (95% CI: 30-121). The area under the HSROC curve was 0.96 (95% CI: 0.94-0.98). No significant difference in sensitivity was found between single-heartbeat and other CT scanners (96% (95% CI: 90 - 99%) vs. 97% (95% CI: 94-98%) respectively; p = 0.37), whereas the specificity of single-heartbeat scanners was higher (82% (95% CI: 66-92%) vs. 60% (95% CI: 46 - 72%) respectively; p < 0.0001). Routine CCTA in the pre-TAVI workup could save 41% (95% CI: 34 - 47%) of ICAs if a disease prevalence of 40% is assumed. CONCLUSIONS: CCTA proved an excellent diagnostic accuracy for assessing obstructive CAD in patients referred for TAVI; the use of single-heartbeat CT scanners can further improve these findings. KEY POINTS: • CCTA proved to have an excellent diagnostic accuracy for assessing obstructive CAD in patients referred for TAVI. • Routine CCTA in the pre-TAVI workup could save more than 40% of ICAs. • Single-heartbeat CT scanners had higher specificity than others in the assessment of obstructive CAD in patients referred for TAVI.

目的：评估冠状动脉计算机断层扫描血管造影术（CCTA）在经导管主动脉瓣植入术（TAVI）患者中评估阻塞性冠状动脉疾病（CAD）的诊断准确性。

方法：检索 EMBASE、PubMed/MEDLINE 和 CENTRAL 以获取报告 CCTA 评估与有创冠状动脉造影（ICA）相比阻塞性 CAD 准确性的研究。使用 QUADAS-2 工具评估偏倚风险。使用双变量随机效应模型分析、汇总和绘制 across studies 的诊断性能测量值。评估汇总敏感性、特异性、阳性（+LR）和阴性（-LR）似然比、诊断优势比（DOR）和分层汇总受试者工作特征（HSROC）曲线。Prospéro 注册号：CRD42021252527。

结果：共纳入 14 项研究（2533 名患者）。在意图诊断的患者水平分析中，CCTA 的敏感性和特异性分别为 97%（95%CI：94-98%）和 68%（95%CI：56-68%），+LR 和 -LR 分别为 3.0（95%CI：2.1-4.3）和 0.05（95%CI：0.03-0.09），DOR 等于 60（95%CI：30-121）。HSROC 曲线下面积为 0.96（95%CI：0.94-0.98）。单心动周期和其他 CT 扫描仪之间的敏感性无显著差异（96%（95%CI：90-99%）与 97%（95%CI：94-98%）；p=0.37），而单心动周期扫描仪的特异性更高（82%（95%CI：66-92%）与 60%（95%CI：46-72%）；p<0.0001）。如果假设疾病患病率为 40%，TAVI 术前常规 CCTA 可节省 41%（95%CI：34-47%）的 ICA。

结论：CCTA 证明在评估 TAVI 患者的阻塞性 CAD 方面具有出色的诊断准确性；使用单心动周期 CT 扫描仪可以进一步提高这些发现。

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