Systematic review, meta-analysis and economic modelling of ...
Systematic review, meta-analysis and economic modelling of ...
Systematic review, meta-analysis and economic modelling of ...
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DOI: 10.3310/hta17010 Health Technology Assessment 2013 Vol. 17 No. 1<strong>analysis</strong> to determine if CTCA provided additional prognostic value beyond routine assessment with ECG<strong>and</strong> biomarkers.Table 28 summarises the results <strong>of</strong> the prognostic studies <strong>of</strong> CTCA. It was not always clear whetherpatients with positive CTCA had been followed up <strong>and</strong> whether there had been any events in thesepatients. MACE rates were generally very low in patients with a negative CTCA. The only adverse event in apatient with negative CTCA was a death in the long-term follow-up cohort <strong>of</strong> Holl<strong>and</strong>er et al. 132 However,these low event rates may reflect selection <strong>of</strong> low-risk patients rather than accurate risk stratificationby CTCA. Most <strong>of</strong> the events reported in patients with positive CTCA findings were process events [i.e.percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG)], which in an unblindedstudy may simply reflect physicians acting upon CTCA findings. No patient with positive or intermediateTABLE 27 Quality assessment <strong>of</strong> CTCA <strong>and</strong> CAC scoring prognostic studiesStudy Q1 Q2 Q3 Q4 Q5 Q6 Q7Goldstein 2007 131 Y Y Y Y Y N NHoll<strong>and</strong>er 2009 132 N Y Y Y Y N NHoll<strong>and</strong>er 2009 133 N Y Y Y Y N NLaudon 2010 151 N Y Y Y Y N NMiller 2011 134 Y Y N Y Y N NRubinshtein 2007 135 N Y Y Y Y N NSchlett 2011 136 Y Y Y Y Y Y YShuman 2010 137 N Y Y Y Y N NN, no; U, unclear; Y, yes.Questions:Q1 Are inclusion criteria defined?Q2 Are characteristics described (age <strong>and</strong> sex)?Q3 Is a MACE defined in the methods section?Q4 Is a MACE identification <strong>and</strong> definition independent <strong>of</strong> the index test?Q5 Is a MACE outcome recorded for at least 80% <strong>of</strong> the cohort from baseline episode?Q6 Was a multivariate <strong>analysis</strong> undertaken?Q7 Was troponin measured <strong>and</strong> included in the multivariate <strong>analysis</strong>?TABLE 28 Outcomes summary for prognostic studies <strong>of</strong> CTCAPaper Positive CTCA a CTCA aIntermediateNegative CTCA aGoldstein 2007 131 0/8 0/24 0/67Holl<strong>and</strong>er 2009 132 NR NR 1/481 (death)Holl<strong>and</strong>er 2009 133 0/13 0/41 0/508Shuman 2010 137 NR NR 0/70Rubinshtein 2007 135 13/23 (two MI, eight PCI, three CABG) 1/20 (PCI) 0/15Miller 2011 134 0/18 – 0/10Schlett 2011 136 20/68 b 5/117 b 0/183a See Table 25 for definitions.b The 25 MACEs included 12 MIs, 23 revascularisations <strong>and</strong> no cardiac deaths.© Queen’s Printer <strong>and</strong> Controller <strong>of</strong> HMSO 2013. This work was produced by Goodacre et al. under the terms <strong>of</strong> a commissioning contract issued by the Secretary <strong>of</strong> Statefor Health. This issue may be freely reproduced for the purposes <strong>of</strong> private research <strong>and</strong> study <strong>and</strong> extracts (or indeed, the full report) may be included in pr<strong>of</strong>essional journalsprovided that suitable acknowledgement is made <strong>and</strong> the reproduction is not associated with any form <strong>of</strong> advertising. Applications for commercial reproduction should beaddressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials <strong>and</strong> Studies Coordinating Centre, Alpha House, University <strong>of</strong> Southampton SciencePark, Southampton SO16 7NS, UK.73