Systemic review and meta-analysis of diagnostic efficacy of fractional flow reserve using computed tomography angiography for first-time diagnosis of coronary artery disease

Narendra Kumar; Ajay Kumar Sinha; Pramod Kumar; Arun Kumar Jha; Karuppiah Arunachalam; Sanjeev Kumar; Ahmad Zakariya; Shaimaa Mostafa

doi:10.4103/rcm.rcm_28_18

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Year : 2018 \| Volume : 7 \| Issue : 4 \| Page : 159-164

Systemic review and meta-analysis of diagnostic efficacy of fractional flow reserve using computed tomography angiography for first-time diagnosis of coronary artery disease Narendra Kumar¹, Ajay Kumar Sinha², Pramod Kumar³, Arun Kumar Jha⁴, Karuppiah Arunachalam⁵, Sanjeev Kumar⁶, Ahmad Zakariya⁷, Shaimaa Mostafa⁸ ¹ Department of Cardiology, Artemis Hospital, Sector 51, Gurugram, Haryana, India ² Department of Cardiology, Paras HMRI Hospitals, NH 30, Bailey Road, Raja Bazar, Patna, Bihar, India ³ Department of Cardiology, Fortis Hospital, A Block, Ring Road, Shalimar Bagh, New Delhi, India ⁴ Department of Cardiology, Indira Gandhi Institute of Cardiology, Ashok Raj Path, PMCH Campus, Patna, Bihar, India ⁵ Department of Cardiology, Warren Alpert Medical School of Brown University, Providence, RI, USA ⁶ Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Science, Patna, Bihar, India ⁷ Department of Cardiology, Northern Devon Healthcare NHS Trust, Raleigh Park, Barnstaple, Devon, EX31 4JB, UK ⁸ Department of Cardiology, Benha University, Faculty of Medicine, Banha, Egypt Correspondence Address: Dr. Narendra Kumar Department of Cardiology, Artemis Hospital, Sector 51, Gurugram, Haryana India Source of Support: None, Conflict of Interest: None DOI: 10.4103/rcm.rcm_28_18

Coronary artery disease is a leading global cause of mortality. It can be diagnosed by fractional flow reserve (FFR) estimation using computed tomography (CT) angiography. This systematic review aims to review the literature about the diagnostic efficacy of FFR estimation using CT scan (FFR-CT) for the diagnosis of coronary artery disease. The dual databases of Medline and Cochrane Central Register of Controlled Trials were searched for relevant literature from their inception till August 15, 2017. The methodological quality was assessed using the Cochrane risk of bias tool. Pooled estimates of specificity and sensitivity were assessed with the corresponding 95% confidence intervals (CI). After careful screening, five studies involving a total of 296 patients were included in the study. For FFR-CT, on meta-analysis of the pooled risk ratio per patient, random-effects model value was 3.79 (95% CI, 2.93–4.90) and odds ratio per patient was 11.78 (95% CI, 8.08–17.17). The odds ratio by year to see if heterogeneity is due to sample size was 2.50 (95% CI, 1.06–5.91). FFR-CT appears to be a reliable and efficacious noninvasive imaging modality, as it demonstrates high accuracy in the determination of anatomy and lesion-specific ischemia, which justifies the performance of additional randomized controlled trials to evaluate the clinical benefits of FFR-CT-guided coronary revascularization.



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