Page 24 - Cardiac testing for coronary artery disease in potential kidney transplant recipients

Summary of results (Continued)

characteristics (e.g. prevalence of chest pain) and test application (diagnostic test threshold, criteria for positive test, choice of stress
agent and stress protocol, and operator variability) likely contributed to heterogeneity, we were hindered from estimating their
contributions because of relatively sparse data, which resulted in low power
Partial verification, where not all patients who received screening tests also received coronary angiography, occurred in 5/25 compar-
isons. This may have affected estimates of sensitivity and specificity
Two different reference standard thresholds (≥ 70% stenosis or ≥ 50% stenosis) were used in the included studies, with most studies
only using one reference standard threshold or the other. An overall analysis pooling the results of all studies regardless of threshold
may introduce additional heterogeneity due to a threshold effect

Results

Test DSE MPS
Number of studies [all studies] 13 9

Number of participants [all studies] 745 582

Pooled sensitivity (95% CI) [all studies] 0.79 (0.67 to 0.88) 0.74 (0.54 to 0.87)

Pooled specificity (95% CI) [all studies] 0.89 (0.81 to 0.94) 0.70 (0.51 to 0.84)

Number of studies [≥ 70% stenosis] 9 7

Number of participants [≥ 70% stenosis] 668 517

Pooled sensitivity (95% CI) [≥ 70% steno- 0.76 (0.60 to 0.87) 0.67 (0.48 to 0.82)
sis]

Pooled specificity (95% CI) [≥ 70% steno- 0.88 (0.78 to 0.94) 0.77 (0.61 to 0.88)
sis]

Number of false diagnoses of ≤ 70% coro- 24 (13 to 40) 33 (18 to 52)
nary artery stenosis in a standard popula- per 100 per 100
tion of 100 patients (false negative rate)

Number of false diagnoses of ≥ 70% coro- 12 (6 to 22) 23 (12 to 39)
nary artery stenosis in a standard popula- per 100 per 100
tion of 1000 patients (false positive rate)

Positive likelihood ratio [≥ 70% stenosis] 6.44 (3.03 to 13.70) 2.89 (1.39 to 5.99)
(95% CI)

Negative likelihood ratio [≥ 70% stenosis] 0.26 (0.13 to 0.50) 0.43 (0.23 to 0.80)
(95% CI)
Post test probability after positive screening 42% to 72% 24% to 54%
test result for a patient with low risk (10%
to 29% pre test probability) disease

Cardiac testing for coronary artery disease in potential kidney transplant recipients (Review) 22
Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.