Electron-beam computed tomography in the diagnosis of coronary artery disease: a meta-analysis

Arch Intern Med. 2001 Mar 26;161(6):833-8. doi: 10.1001/archinte.161.6.833.


Background: Electron-beam computed tomography (EBCT) is a new, noninvasive method of detecting coronary artery calcification that is being increasingly advocated as a diagnostic test for coronary artery disease (CAD). Before its clinical use is justified, however, the overall accuracy of EBCT must be better defined.

Objective: To estimate the accuracy of EBCT in diagnosing obstructive CAD.

Data sources: English-language studies from January 1, 1979, through February 29, 2000, were retrieved using MEDLINE and Current Contents databases, bibliographies, and expert consultation.

Study selection: We included a study if it (1) used EBCT as a diagnostic test; (2) reported cases in absolute numbers of true-positive, false-positive, true-negative, and false-negative results; and (3) used coronary angiography as the reference standard for diagnosing obstructive CAD (defined as > or = 50% diameter stenosis).

Data extraction: Data were extracted from the included articles by 2 independent reviewers.

Data synthesis: Weighted pooled analysis and summary receiver operating characteristic (ROC) curve analysis were used to determine sensitivity and specificity rates. Results from 9 studies with 1662 subjects were included. Pooled sensitivity for EBCT was 92.3% (95% confidence interval [CI], 90.7%-94.0%) and pooled specificity was 51.2% (95% CI, 47.5%-54.9%). Maximum joint sensitivity and specificity for EBCT from its summary ROC curve was 75%. As the threshold for defining an abnormal test varied, sensitivity and specificity changed. For a threshold that resulted in a sensitivity of 90%, specificity was 54%; when sensitivity was 80%, specificity rose to 71%.

Conclusion: The performance of EBCT as a diagnostic test for obstructive CAD is reasonable based on sensitivity and specificity rates from its summary ROC curve.

Publication types

  • Meta-Analysis
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Coronary Disease / diagnostic imaging*
  • Eligibility Determination
  • Female
  • Humans
  • Male
  • Middle Aged
  • ROC Curve
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Tomography, X-Ray Computed*