To assess the diagnostic role of coronary computed tomography angiography (CCTA) and fractional flow reserve computed tomography (FFRCT) in confirming or excluding ischemic coronary artery disease (CAD) and to provide a rational use of CCTA and FFRCT in different pre-test probability (PTP) of CAD.
We searched the electronic databases from the earliest relevant literature to July 2020 comparing FFRCT or CCTA with FFR. The bivariate random-effects models and Bayes’ theorem were used to investigate the diagnostic performance of CCTA and FFRCT with the sensitivity, specificity, pre- and post-test probability.
Fifty-three articles with 4817 patients and 7026 vessels finally met our inclusion criteria. At the patient level, the sensitivity and specificity of CCTA were (0.94, 0.89-0.97), and (0.50, 0.43-0.58), respectively. For FFRCT, the sensitivity and specificity were (0.90, 0.87-0.93) and (0.81, 0.73-0.87). CCTA or FFRCT could increase the post-test probability to >85 % in patients with a PTP > 74.9 % or 54.5 %; CCTA or FFRCT could decrease the post-test probability to <15 % in patients with a pre-test probability <61.3 % or 59.3 %.
In patients with low to intermediate PTP, CCTA is suggested to exclude CAD, while the time-consuming calculation of FFRCT may be unnecessary. If CCTA detects significant or uncertain stenosis with intermediate to high PTP of CAD, further FFRCT is suggested. The advantages of FFRCT for guiding CAD treatment have sufficiently been demonstrated.

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