Download the full report (116 p.) - KCE

More documents

Recommendations

Info

64 Multislice CT in Coronary Heart Disease KCE Reports 82 9 CONCLUSIONS 9.1 TECHNICAL EFFICACY 64-SCT has shown to be able to image native coronary arteries with acceptable quality in selected patient populations. Patients should be in a stable sinus rhythm, they shoud be not too obese, they should be able to cooperate and they should have non-calcified coronary arteries. The high burden of ionizing radiation remains a major obstacle. It is currently not clear whether future technical improvements will lead to less radiation yet preserve adequate diagnostic performance. 9.2 DIAGNOSTIC ACCURACY The diagnostic accuracy of MSCT in CAD has been thoroughly tested predominantly in patients at high-risk in whom it had already been decided to proceed to CCA, or in whom the results of CCA were already available. In these populations the technique can very well document normal coronary arteries and can adequately rule out obstructive CAD. The test’s specificity is less than optimal, leading to false positives, especially in lower prevalence populations. The diagnostic performance of MSCT in real world clinical practice is not known. 9.3 DIAGNOSTIC THINKING Only limited data are available supporting the use of MSCT with regard to its role within patient care algorithms. The test performs best in patients with normal coronary arteries, but it has yet to be ascertained whether these (normal) patients could not have been identified otherwise in a safer and more cost-effective way. 9.4 THERAPEUTIC IMPACT If MSCT performs in real world as good as in clinical trials, it might be a useful test to exclude significant CAD. Documenting obstructive CAD by MSCT is of rather limited value, because patient management and prognosis depend on the functional impact of the coronary stenosis which cannot be assessed by MSCT alone. Moreover, in case revascularisation is deemed appropriate, invasive CCA is inevitable. 9.5 PATIENT OUTCOMES There is limited data on the prognostic value of MSCT and there is no evidence whatsoever that the use of MSCT improves quality of life, prevents heart attacks or saves lives. 9.6 COST-EFFECTIVENESS A full economic evaluation of MSCT requires more data on the clinical effectiveness of this diagnostic technique in preventing morbidity and mortality. It is yet impossible to conclude whether MSCT is cost-effective compared to the standard diagnostic protocols in low to intermediate risk patients.
KCE Reports 82 Multislice CT in Coronary Heart Disease 65 10 APPENDICES QUALITY ASSESSMENT OF SYSTEMATIC REVIEWS Figure 4: Checklist of the Dutch Cochrane Centre, items 1 through 7. (http://www.cochrane.nl/index.html) The SR by Abdulla 66 and by Vanhoenacker 73 did not provide a quality score of the included studies. Hamon 39 and Vanhoenacker 81 made use of the QUADAS tool for quality assessment. Other items were scored similarly by the four SR that were reported on. The quality of the meta-analysis methodology could not be adequately assessed. Items 9 through 12 of the checklist from the Dutch Cochrane Centre (not shown in Figure 4) could not be rated because it was concluded that the diagnostic performance, resulting from these meta-analyses, lacked external validity because of the highly selected populations that were included in the different studies.
Page 1 and 2:
64-Slice computed tomography imagin
Page 3:
64-Slice computed tomography imagin
Page 6 and 7:
KCE reports 82 C Multislice CT in C
Page 8 and 9:
Page 10 and 11:
Page 13 and 14:
KCE Reports 82 Multislice CT in Cor
Page 15 and 16:
Page 17 and 18:
Page 19 and 20:
Page 21 and 22:
Page 23 and 24:
Page 25 and 26: KCE Reports 82 Multislice CT in Cor
Page 75: KCE Reports 82 Multislice CT in Cor
Page 113 and 114: This page is left intentionally bla
Page 115: KCE reports 33 Effects and costs of
show all

Download the full report (116 p.) - KCE

Create successful ePaper yourself

Delete template?

Save as template?