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Meta-analysis of diagnostic efficacy of 64-slice computed tomography in the evaluation of coronary in-stent restenosis
The American Journal of Cardiology, 06/22/09

Kumbhani DJ et al. – Results show that 64-slice computed tomography (CT) can detect (high sensitivity and specificity) or exclude in-stent restenosis (ISR) (high negative predictive value [NPV]) with; however, precise quantification of ISR is inaccurate (low positive predictive value [PPV]). Efficacy estimates are even lower with inclusion of nonassessable segments; thus stress imaging remains the most acceptable noninvasive technique for diagnosis of ISR.

Methods

Meta-analysis for diagnostic efficacy of 64-slice CT in evaluation of ISR
Inclusion of studies that used 64-slice CT for evaluation of coronary ISR
Pool of efficacy estimates across studies using random-effects models

Results

Optimal noninvasive assessment by 64-slice CT of coronary artery disease
Various artifacts limit evaluation of stented coronary segments
Of 14 studies, 895 pts: 1,447 stents, mean diameter 3.1 mm
Of 1,447 stents, 1,231 (91.4%) stents adequately assessed by 64-slice CT
Overall 91% sensitivity; 91% specificity; 68% PPV; 98% NPV
On inclusion of nonassessable segments, overall sensitivity and specificity decreased to 87% and 84%, with PPV of 53% and an NPV of 97%, respectively

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