Cardiac fluoroscopy for the diagnosis of coronary artery disease: a meta analytic review

To evaluate variability in the reported accuracy of fluoroscopically detected coronary calcific deposits for predicting angiographic coronary disease, we applied meta analysis to 13 consecutively published reports comparing the results of cardiac fluoroscopy with coronary angiography. Population characteristics and technical and methodologic factors were analyzed. Sensitivity and specificity for predicting serious coronary disease compare quite well with those from the literature on the exercise ECG and the exercise thallium scintigram. Sensitivity increases and specificity decreases more significantly with patient age, and sensitivity is paradoxically lower in laboratories testing patients with more severe disease, as well as when 70% rather than 50% diameter narrowing is used to define angiographic disease. Work-up and test review bias were also significantly related to reported accuracy.