Noninvasive Technologies for Diagnosing Coronary Artery Disease in Women
Accuracy of NITs in Diagnosing CAD in Symptomatic Women Without a Known Diagnosis of CAD (2 of 2)
The accuracy of the various noninvasive technologies (NITs) used to diagnose coronary artery disease (CAD) in symptomatic women with no known CAD was assessed. The findings are as follows:
Accuracy of cardiac magnetic resonance imaging (CMR):
Five studies reported on CMR imaging use in 637 women with no known CAD; all 5 were good-quality studies. In these studies, sensitivity varied from 58 to 84 percent, and specificity varied from 59 to 96 percent; the median sensitivity was 79 percent, and the median specificity was 88 percent. The strength of evidence for CMR as a diagnostic tool was low.
Accuracy of coronary computed tomography angiography (CTA):
Five studies reportedn CTA use in 317 women with no known CAD. In these studies, sensitivity varied from 70 to 100 percent, and specificity varied from 46 to 91 percent; the median sensitivity was 89 percent, and the median specificity was 75 percent. In the 3 good-quality studies in women with no known CAD, sensitivity varied from 70 to 100 percent, and specificity varied from 46 to 91 percent; the median sensitivity was 86 percent, and the median specificity was 73 percent. The strength of evidence for coronary CTA as a diagnostic tool was low.
An analysis to determine a statistical difference between the accuracies of NITs for diagnosing CAD in women with no known CAD revealed that:
- For women with no previously known CAD, there were statistically significant differences between the performance of the available modalities (p < 0.001).
- In the subset of studies that were of good quality and where there was no known CAD in the included population, the specificities of CMR and ECHO were statistically significantly higher than that of ECG (p = 0.006).
CMR = cardiac magnetic resonance imaging; CTA = computed tomography angiography; ECG = electrocardiography; ECHO = echocardiography; SPECT = single photon positron emission tomography
Keywords: accuracy | CAD | diagnosis | evidence | findings | noninvasive technologies | sensitivity | specificity | women | coronary artery disease
- Dolor RJ, Patel MR, Melloni C, et al. Noninvasive Technologies for the Diagnosis of Coronary Artery Disease in Women. Comparative Effectiveness Review No. 58 (Prepared by the Duke Evidence-based Practice Center under Contract No. 290-2007-10061-I). Rockville, MD: Agency for Healthcare Research and Quality; June 2012. AHRQ Publication No. 12-EHC034-EF. Available at www.effectivehealthcare.ahrq.gov/diagnosecad.cfm.
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