Correlation of stress testing with anatomically significant coronary artery disease in the contemporary patient population. (14th October 2021) - Choudhary, J
Abstract: Background: The purpose of this study was to determine the accuracy and validity of stress testing compared to anatomic correlation at the level of individual coronary arteries. Methods: PubMed, Embase, and the Cochrane Library were used to identify studies published between 2000 and 2020 comparing physiologic stress tests such as SPECT, PET, and echocardiography to an anatomical reference standard (CT coronary angiography or invasive coronary angiography) on a per-vessel level, and pooled analyses were conducted. Results: Forty-one studies reporting ischemia at the level of at least one coronary artery were identified (N=4, 778). For LAD, pooled sensitivity (sens) was 74% (95% CI: 69%-77%), specificity (spec) – 82% (95% CI: 79%-84%), positive likelihood ratio (LR) – 4.02 (95% CI: 3.42–4.73), negative LR – 0.32 (95% CI: 0.28–0.37), and DOR – 12.46 (95% CI: 9.58–16.20). For LCX, sens – 64% (95% CI: 59%-69%), spec – 86% (95% CI: 83%-89%), positive LR – 4.69 (95% CI: 3.84–5.74), negative LR – 0.41 (95% CI: 0.36–0.47), and DOR – 11.35 (95% CI: 8.61–14.96). Similarly, for RCA, sens – 71% (95% CI: 66%-75%), spec – 84% (95% CI: 81%-87%), positive LR – 4.42 (95% CI: 3.65–5.36), negative LR – 0.35 (95% CI: 0.30–0.40), and DOR – 12.64 (95% CI: 9.59–16.65). LAD ischemia was more significantly correlated with significant stenosis, and LCX was the least (p<0.001). Conclusion: There appears to be only modest correlation of physiologic ischemia with anatomically significant coronary artery disease, and this varies according to specific coronary artery territory. FUNDunding Acknowledgement: Type of funding sources: None.