Sixteen studies (n=960) were included in the review. Methodological quality was considered to be satisfactory; most studies fulfilled most of the 12 quality criteria.
Coronary CT angiography was associated with high sensitivity and specificity and demonstrated comparable diagnostic performance to the reference standard. At the patient-level (12 studies), pooled sensitivity was 1.00 (95% CI 0.98 to 1.00) and specificity was 0.89 (95% CI 0.85 to 0.92). There was no statistical heterogeneity. Sensitivities were similarly high at the vessel level (0.97, 95% CI 0.95 to 0.98; 13 studies) and segment level (0.91, 95% CI 0.86 to 0.95; 13 studies). The highest pooled specificity was at the segment level (0.96, 95% CI 0.94 to 0.97). Statistically significant heterogeneity
was found between vessel-level and segment-level analyses.
Positive and negative likelihood ratios were reported in the paper. BMI and coronary artery disease prevalence were associated with variations in diagnostic performance. Sensitivity analysis showed no material difference in outcome. There was no evidence of publication bias.
An analysis of adverse events was not possible due to the low number of studies that provided data (three studies).