Diagnostic value of coronary CT angiography with prospective ECG-gating in the diagnosis of coronary artery disease: a systematic review and meta-analysis

To perform a systematic review and meta-analysis of the diagnostic value of prospective ECG-gating coronary CT angiography in the diagnosis of coronary artery disease. A search of biomedical databases for English literature was performed to identify studies investigating the diagnostic value of 64- or more slice CT angiography with use of prospective ECG-gating in the diagnosis of coronary artery disease. Sensitivity, specificity, positive and negative predictive value estimates pooled across studies were tested using a fixed effects model. Fourteen studies met selection criteria for inclusion in the analysis. Pooled estimates and 95% confidence interval (CI) of sensitivity, specificity, positive and negative predictive value of prospective ECG-gating coronary CT angiography for diagnosis of significant coronary stenosis were 99% (95% CI: 98, 100%), 91% (95% CI: 88, 94%), 94% (95% CI: 91, 96%) and 99% (95% CI: 97, 100%), according to the patient-based assessment. The mean values of sensitivity, specificity, positive and negative predictive value of prospective ECG-gating coronary CT angiography were 95% (95% CI: 93, 96%), 95% (95% CI: 93, 95%), 88% (95% CI: 86, 90%), and 98% (95% CI: 97, 98%), according to vessel-based assessment; 92% (95% CI: 90, 93%), 97% (95% CI: 97, 98%), 84% (95% CI: 82, 86%), 99% (95% CI: 99, 99%), according to segment-based assessment, respectively. The mean effective dose was 3.3 mSv (95% CI: 2.3, 4.1 mSv) for the prospective ECG-gating coronary CT angiography. This analysis shows that for a predominantly male population with a high disease prevalence the use of coronary CT angiography with prospective ECG gating allows for a reduced radiation exposure without a sacrifice in diagnostic efficacy.