Systematic Evaluation Of The Sensitivity And Specificity Of Coronary Heart Disease Risk Assessment Tools

Research Purpose:1.To evaluate the quality of the literatures about the risk of coronary heart disease and the risk of prognosis by the risk assessment tools,and to understand the quality status of the relevant diagnostic tests;2.to systematically evaluate the sensitivity and specificity of different risk assessment tools for coronary heart disease;3.To explore the practical value of coronary heart disease risk assessment tools for clinical nursing,in order to provide reference for related research in China,and to provide reference for patients with coronary heart disease to develop personalized assessment programs and nursing measures.Research Methods:The sensitivity and specificity of different coronary heart disease risk assessment tools in PubMed,Elsevier,Cochrane Library,CINAHL,web of knowledge,Scopus,Chinese biomedical literature database(CBM),Chinese Journal of science and technology database(VIP),CNKI,Wanfang and other databases were searched.The time limit was from the establishment of the database to July 31,2019.Two researchers examined the literature in strict accordance with the inclusion and exclusion criteria,and evaluated the quality of the literature on the basis of the research quality evaluation of diagnostic accuracy.Then meta-disc1.4,Revman 5.3 and stata15.1 were used to extract the data,and meta analysis was carried out.Research Results:There are 14 documents,including 21 studies,covering 10 countries.The evaluation results of literature quality of quadas-2 show that there are some deficiencies in some studies,but the literature quality is generally good,with the highest score of 10 [46,50,53],the lowest score of 7 [54,58],and the average score of 8.79 ± 0.94.Because of the high clinical heterogeneity between the involved studies,a randomized model was selected for meta-analysis and subgroup analysis.The combined values of sensitivity(SEN)and specificity(SPE)were 0.88(95% CI: 0.86,0.89),0.39(95% CI: 0.39,0.40),1.90(95% CI:1.68,2.14),0.33(95% CI: 0.25,0.44),0.57(95% CI: 4.48,9.62)and 0.79(AUC)respectively.The results of subgroup analysis showed that the diagnostic accuracy of imaging examination was better than that of guideline assessment tool(AUC = 0.87 vs 0.68),prospective study design was better than retrospective study design(AUC = 0.78 vs 0.89),coronary heart disease group was better than non coronary heart disease group(AUC = 0.87 vs 0.77),Occident was better than other races(AUC = 0.88 vs 0.71),Framingham score was better than other reference standards(AUC = 0.71 vs 0.83).Meta regression results showed that there was no significant difference in sensitivity among the five subgroups.For specificity,whether it is a subgroup variable of study design,race and reference standard is statistically significant,indicating that study design,race and reference standard may be the source of heterogeneity.The results of sensitivity analysis showed that the confidence interval and the original value of each evaluation index were mostly coincident after the small sample(n < 50)[48-49],the low-quality sample(QUADAS score < 8)[54-58] and the low-quality small sample were eliminated,which indicated that the results were reliable.According to the deek symmetry test,21 studies may have published bias(bias = 17.13,P = 0.02 < 0.05),but no bias was found in each subgroup(P > 0.05).Research Conclusion:The results show that the accuracy of image diagnosis is high,and coronary angiography has high sensitivity,which can be used for preliminary screening of coronary heart disease and reduce the rate of missed diagnosis.The specificity of quantitative blood flow fraction(QFR)of CT is the highest 0.96(95% CI: 0.81,1.00).It can be used for accurate assessment and risk classification of coronary heart disease,and can reduce the misdiagnosis rate.Because of its high sensitivity,it is recommended that the guidelines be used as an early screening tool for coronary heart disease risk.Due to the lack of research and some limitations,the results need to be further tested.Researchers should pay attention to the quality of research related to coronary heart disease risk assessment tools,and comprehensively consider the indicators of sensitivity and specificity.If necessary,joint trials can be carried out to improve the accuracy and scientificity of diagnosis and provide the basis for clinical intervention.