Abstract
To determine diagnostic performance of non-invasive tests using invasive fractional flow reserve (FFR) as reference standard for coronary artery disease (CAD).
Medline, Embase, and citations of articles, guidelines, and reviews for studies were used to compare non-invasive tests with invasive FFR for suspected CAD published through March 2017.
Seventy-seven studies met inclusion criteria. The diagnostic test with the highest sensitivity to detect a functionally significant coronary lesion was coronary computed tomography (CT) angiography [88%(85%–90%)], followed by FFR derived from coronary CT angiography (FFRCT) [85%(81%–88%)], positron emission tomography (PET) [85%(82%–88%)], stress cardiac magnetic resonance (stress CMR) [81%(79%–84%)], stress myocardial CT perfusion combined with coronary CT angiography [79%(74%–83%)], stress myocardial CT perfusion [77%(73%–80%)], stress echocardiography (Echo) [72%(64%–78%)] and stress single-photon emission computed tomography (SPECT) [64%(60%–68%)]. Specificity to rule out CAD was highest for stress myocardial CT perfusion added to coronary CT angiography [91%(88%–93%)], stress CMR [91%(90%–93%)], and PET [87%(86%–89%)].
A negative coronary CT angiography has a higher test performance than other index tests to exclude clinically-important CAD. A positive stress myocardial CT perfusion added to coronary CT angiography, stress cardiac MR, and PET have a higher test performance to identify patients requiring invasive coronary artery evaluation.
•CTCA is an excellent tool to rule out obstructive CAD.•FFRCT or stress CTP improve the post-test likelihood of significant CAD.•PET, CMR, and CTCA combined with CTP showed the highest positive likelihood ratio.