Introduction: Coronary computed tomography angiography (CCTA) is emerging as an important noninvasive testing modality for coronary angiography. The performance characteristic of CCTA in patients with advanced kidney disease is unknown. Methods: We performed a systematic review and meta-analysis of studies specifically investigating the sensitivity and specificity of CCTA compared to coronary angiogram as a reference standard in patients with advanced kidney disease, defined as dialysis dependence or nearing kidney transplantation. Two independent investigators assessed studies for inclusion/exclusion, quality, and characteristics, while a third investigator adjudicated. Results: We identified 4 studies including a total of 217 patients, of whom 159 were dialysis dependent. Three of the 4 studies had a high risk of bias in patient selection and study flow, while 1 study rated low in all areas of bias. The studies were heterogeneous in their patient selection and CCTA protocol but consistent in their definition of obstructive coronary artery disease. The pooled sensitivity and specificity for CCTA were 0.96 (0.87–0.99) and 0.66 (0.57–0.74), respectively. When we restricted the analysis to dialysis-dependent patients, the pooled sensitivity and specificity for CCTA were 0.99 (0.74–1.00) and 0.67 (0.49–0.82), respectively. Conclusions: Based on limited data, CCTA appears to have comparable sensitivity but lower specificity relative to the non-kidney disease population.
Cardiorenal Med

中文翻译：

---

冠状动脉计算机断层扫描血管造影诊断晚期慢性肾病患者阻塞性冠状动脉疾病：系统评价和荟萃分析

简介：冠状动脉 CT 血管造影 (CCTA) 正在成为一种重要的冠状动脉造影的无创检测方式。CCTA 在晚期肾病患者中的表现特征尚不清楚。方法：我们对研究进行了系统回顾和荟萃分析，专门研究 CCTA 与冠状动脉造影作为参考标准在晚期肾病患者中的敏感性和特异性，定义为透析依赖或接近肾移植。两名独立调查员评估研究的纳入/排除、质量和特征，而第三名调查员进行裁决。结果：我们确定了 4 项研究，包括总共 217 名患者，其中 159 名依赖透析。4 项研究中的 3 项在患者选择和研究流程方面存在高偏倚风险，而 1 项研究在所有偏倚领域均评分较低。这些研究在患者选择和 CCTA 方案方面存在异质性，但对阻塞性冠状动脉疾病的定义是一致的。CCTA 的汇总敏感性和特异性分别为 0.96 (0.87-0.99) 和 0.66 (0.57-0.74)。当我们将分析限制在依赖透析的患者时，CCTA 的汇总敏感性和特异性分别为 0.99（0.74-1.00）和 0.67（0.49-0.82）。结论：基于有限的数据，相对于非肾脏疾病人群，CCTA 似乎具有相当的敏感性，但特异性较低。
心肾医学