Pharmacologic stress testing for coronary disease diagnosis: A meta-analysis

Background Although noninvasive pharmacologic stress tests are widely used, their relative performance is not clear. We compared the performance of pharmacologic stress tests combined with echocardiography or nuclear imaging for the diagnosis of coronary disease. Methods We performed a regression meta-analysis of published data. We included studies published between January 1975 and June 1999 in which subjects underwent echocardiographic or single-photon emission computed tomography (SPECT) stress testing with adenosine, dipyridamole, or dobutamine for diagnosis of coronary artery disease. All subjects also underwent coronary angiography. Two independent reviewers abstracted population characteristics, technical factors, methodologic factors, and results and calculated test sensitivity and specificity. Results Eighty-two studies met the inclusion criteria. The sensitivity of dipyridamole SPECT imaging, 89% (95% Cl, 84%-93%), was higher than that of dipyridamole echocardiography, but the specificity of dipyridamole SPECT imaging, 65% (95% Cl, 54%-74%), was lower than that of dipyridamole echocardiography. Dipyridamole and adenosine tests had similar sensitivities and specificities. The sensitivity of dobutamine echocardiography, 80% (95% Cl, 77%-83%) was similar to that of dobutamine SPECT imaging, but dobutamine echocardiography had a higher specificity, 84% (95% Cl, 80%-86%) than dobutamine SPECT imaging did. Conclusions The findings of our study can be used to guide the selection of the optimal pharmacologic stress test for each patient. Maximum sensitivity can be attained by use of a vasodilator combined with SPECT imaging. Maximum specificity can be attained by use of a vasodilator with echocardiography. The highest combination of sensitivity and specificity can be attained with dobutamine echocardiography.