Table 185 GRADE assessment of body of evidence for change in management after SP-CMR in patients suspected of having CAD Outcome No. of participants, Risk of Inconsistency Indirectness Imprecision Other Result Quality of Importance No. of studies and bias considerations evidence study design Risk Not Mostly patients in the intermediate Very low Low N=1,275 Not serious Not serious Not serious none reclassification serious group were recategorised. importance ⨁⨀⨀⨀ k=3 case series 18%–65.7% were reclassified as low risk. 16%–25.8% were reclassified as high risk. Change in N=27,301 Not Not serious Not serious Not serious none CMR findings led to a completely new Very low Important clinical diagnosis serious diagnosis not previously suspected in ⨁⨀⨀⨀ k=1 case series 8.1% of cases Change in N=27,301 Not Not serious Not serious Not serious none Overall impact on patient Very low Important therapy/clinical serious management (new diagnosis and/ or ⨁⨀⨀⨀ k=1 case series management therapeutic consequence) = 71.4% Diagnostic tests N=27,301 Not Not serious Not serious Not serious none ICA 4,555/10,113 (45%) Very low Important avoided serious ⨁⨀⨀⨀ k=1 case series SPECT/PET 3,946/10,113 (39%) CTCA 2,202/10,113 (22%) Frequency of N=2,398 Not Not serious Not serious Not serious none No ischaemia 6-11% Very low Important ICA after serious ⨁⨀⨀⨀ k=2 case series PD only 55–56%) LGE, no WMA 34% WMA ± PD or LGE 68% PD + WMA 82% CMR-related N=3,330 Not Not serious Not serious Not serious none No ischaemia 2-4% Very low Important revascularisation serious ⨁⨀⨀⨀ k=3 case series LGE only 11–20% PD only 22–29%) LGE + PD 24%
Table 185 GRADE assessment of body of evidence for change in management after SP-CMR in patients suspected of having CAD Outcome No. of participants, No. of studies and study design Risk of bias Inconsistency Indirectness Imprecision Other considerations Result Quality of evidence Importance Risk reclassification N=1,275 k=3 case series Not serious Not serious Not serious Not serious none Mostly patients in the intermediate group were recategorised. 18%–65.7% were reclassified as low risk. 16%–25.8% were reclassified as high risk. Very low ⨁⨀⨀⨀ Low importance Change in clinical diagnosis N=27,301 k=1 case series Not serious Not serious Not serious Not serious none CMR findings led to a completely new diagnosis not previously suspected in 8.1% of cases Very low ⨁⨀⨀⨀ Important Change in therapy/clinical management N=27,301 k=1 case series Not serious Not serious Not serious Not serious none Overall impact on patient management (new diagnosis and/ or therapeutic consequence) = 71.4% Very low ⨁⨀⨀⨀ Important Diagnostic tests avoided N=27,301 k=1 case series Not serious Not serious Not serious Not serious none ICA 4,555/10,113 (45%) SPECT/PET 3,946/10,113 (39%) CTCA 2,202/10,113 (22%) Very low ⨁⨀⨀⨀ Important Frequency of ICA after N=2,398 k=2 case series Not serious Not serious Not serious Not serious none No ischaemia 6-11% PD only 55–56%) LGE, no WMA 34% WMA ± PD or LGE 68% PD + WMA 82% Very low ⨁⨀⨀⨀ Important CMR-related revascularisation N=3,330 k=3 case series Not serious Not serious Not serious Not serious none No ischaemia 2-4% LGE only 11–20% PD only 22–29%) LGE + PD 24% Very low ⨁⨀⨀⨀ Important