Abstract Body: Background: Coronary artery disease (CAD) is the leading cause of cardiovascular mortality (CVD), accounting for 1 in 5 CVD-related deaths. The advent of noninvasive imaging modalities has driven the use of myocardial perfusion imaging (MPI) to improve diagnostic accuracy and clinical outcomes.
Objectives: Building on the role of myocardial perfusion imaging (MPI), this meta-analysis assesses the diagnostic accuracy of the Discovery NM 530c CZT SPECT for CAD compared with invasive coronary angiography (ICA ± FFR) and noninvasive modalities, including PET, MRI, and coronary CT angiography.
Methodology: We systematically searched six databases, identifying 1,587 studies, with 9 meeting inclusion criteria (510 patients, ≥18 years, known/suspected CAD). NM 530c CZT-SPECT was compared with coronary angiography (±FFR), PET, MRI, or coronary CTA within 90 days. Diagnostic test accuracy was assessed using sensitivity, specificity, predictive values, AUC, and DOR, analyzed in R (Version 2024.12.0+467) using "mada" and related packages.
Results: Results: In bivariate analysis, NM 530c CZT-SPECT showed pooled sensitivity of 0.804 (95% CI: 0.751–0.848) and specificity of 0.793 (95% CI: 0.722–0.850) with low heterogeneity (29.8% and 26.2%, respectively). The diagnostic odds ratio (DOR) was 14.19 (95% CI: 8.47–23.77), confirming high diagnostic accuracy. On subgroup analysis, the comparator group had no significant impact on DOR (QM (df = 1) = 0.100, p = 0.752). Against ICA, sensitivity was 0.814 (95% CI: 0.726–0.878) and specificity 0.731 (95% CI: 0.638–0.807) with minimal heterogeneity (2.4%). AUC of 0.84 underscores its clinical reliability.
Conclusion: NM 530c CZT-SPECT exhibits high diagnostic accuracy, with consistent sensitivity and modestly lower specificity than other invasive and noninvasive modalities. Its high AUC underscores its reliability for CAD assessment in clinical practice.