Diagnostic performance of non-invasive imaging for stable coronary artery disease: A meta-analysis

Gianluca Pontone, Andrea I. Guaricci, Suetonia C. Palmer, Daniele Andreini, Massimo Verdecchia, Laura Fusini, Valentina Lorenzoni, Marco Guglielmo, Giuseppe Muscogiuri, Andrea Baggiano, Mark G. Rabbat, Filippo Cademartiri, Giovanni F. Strippoli

Research output: Contribution to journalArticlepeer-review


Background: To determine diagnostic performance of non-invasive tests using invasive fractional flow reserve (FFR) as reference standard for coronary artery disease (CAD). Methods: 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. Results: 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%)]. Conclusion: 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.

Original languageEnglish
Pages (from-to)276-281
Number of pages6
JournalInternational Journal of Cardiology
Publication statusPublished - Feb 1 2020


  • Coronary artery disease
  • Diagnostic pathway
  • Fractional flow reserve
  • Meta-analysis
  • Non-invasive test

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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