Curriculum in CardiologyStress echocardiography, stress single-photon-emission computed tomography and electron beam computed tomography for the assessment of coronary artery disease: A meta-analysis of diagnostic performance
Section snippets
Study selection
A literature search was performed in the Cochrane Library and in PubMed from January 1990 through December 2006 to identify meta-analyses on the diagnostic performance of noninvasive imaging tests for the diagnosis of coronary artery disease. We used the following search terms: (echocardiography OR single-photon-emission computed tomography OR electron beam computed tomography) AND coronary AND specificity, limited to meta-analyses. We also checked the references of the included articles for
Study selection
The search strategy resulted in 120 abstracts, of which 16 meta-analyses were found that reported on coronary artery disease.4, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25 Of the 16 meta-analyses, one study was excluded because it was published before 1990.12 One meta-analysis did not report the absolute numbers of true-positive, false-positive, true-negative, and false-negative test results of the source studies.15 The author of this meta-analysis was requested to provide the
Discussion
In this study, we combined data from over 35,000 patients who underwent 9 different noninvasive imaging technologies for coronary artery disease. The analysis showed that the differences in diagnostic performance between the coronary tests were small. We showed that stress SPECT and EBCT are more sensitive tests, whereas stress echocardiography is more specific. The diagnostic odds ratios, however, did not differ significantly between the imaging modalities, indicating equal diagnostic
Acknowledgement
The authors thank C. Kim for providing the absolute numbers of test results from the source studies included in her meta-analyses.
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Financial support for this study was provided by a Program Grant (904-66-091) from the Netherlands Organization for Scientific Research and by a grant from the American Society of Echocardiography.