Purpose: The current literature reports a wide range of diagnostic accuracy of non-contrast magnetic resonance coronary angiography (NC-MRCA) for the assessment of coronary artery disease (CAD). We aimed to compare the clinical effectiveness of NC-MRCA with that of invasive coronary angiography (ICA) in patients with suspected CAD using a systematic review and meta-analysis.
Methods: Two investigators independently extracted 36 published manuscripts between 2010 and 2019. Databases including Medline, Web of Knowledge, Google Scholar, Scopus, and Cochrane were searched using pre-established keywords. Analysis of the data followed the PRISMA statement for reporting systematic reviews and meta-analyses and primary analysis followed the Mantel-Hansel methodology. Correctness of classification for detecting coronary artery stenosis ≥50% (CAS) was measured using ICA as the gold standard.
Results: A total of five studies met inclusion criteria, with a total of 417 patients and 2883 coronary segments. The pooled per patient sensitivity and specificity of NC-MRCA for CAS in suspected patients was 90.3% (95% CI 85.6-95.1%) and 77.9% (95% CI 69.5-86.3%). Pooled per vessel assessment of NC- MRCA revealed a sensitivity of 83.7% (95%CI 79.7-87.8%) and specificity of 90.0% (95%CI 86.7-93.4%). Per-segment assessment of NC-MRCA showed a pooled sensitivity of 81.6% (95% CI 76.8-86.4) and specificity of 97.0% (95% CI 95.5-98.5). Mild to moderate heterogeneity was noted in most diagnostic parameters with larger heterogeneity noted in the per-segment analyses. There was less heterogeneity in sensitivity and NPV than specificity and PPV.
Conclusion: According to this meta-analysis, non-contrast coronary MRA resulted in adequate screening in patients with suspected CAD with high sensitivity and specificity. This result was true for per-patient, per-vessel, and per-segment assessment.
Keywords: Accuracy; Coronary angiography; Coronary artery disease; Non-contrast magnetic resonance angiography.
© 2021 Published by Elsevier Ltd.