Journal Article

Functional compared to anatomical imaging in the initial evaluation of patients with suspected coronary artery disease: An international, multi-center, randomized controlled trial (IAEA-SPECT/CTA study)

Altin, Timucin, Paez, Diana, Meave, Aloha, Devasenapathy, Niveditha, Jug, Borut, Karthikeyan, Ganesan, Patel, Chetan, Trevethan, Sergio, Cerci, Rodrigo, Soydal, Cigdem, Vitola, Joao, Dondi, Maurizio, Jonszta, Tomáš, Guzic Salobir, Barbara, Purohit, Gaurav, Kraft, Otakar, Ozkan, Elgin, Gotthardtová, Lucia, Sharma, Saket, Gulati, Gurpreet, Kashyap, Ravi, Alexanderson, Erick, Dolenc Novak, Maja, Zier, Sandra

2017

نظرة عامة

To test the hypothesis that, in the initial evaluation of patients with suspected coronary artery disease (CAD), stress myocardial perfusion imaging (MPI) would result in less downstream testing than coronary computed tomographic angiography (CCTA). In this international, randomized trial, mildly symptomatic patients with an intermediate likelihood of having CAD, and asymptomatic patients at intermediate risk of cardiac events, underwent either initial stress-rest MPI or CCTA. The primary outcome was downstream noninvasive or invasive testing at 6 months. Secondary outcomes included cumulative effective radiation dose (ERD) and costs at 12 months. We recruited 303 patients (151 MPI and 152 CTA) from 6 centers in 6 countries. The initial MPI was abnormal in 29% (41/143) and CCTA in 56% (79/141) of patients. Fewer patients undergoing initial stress-rest MPI had further downstream testing at 6 months (adjusted OR 0.51, 95% CI 0.28-0.91, P = 0.023). There was a small increase in the median cumulative ERD with MPI (9.6 vs. 8.8 mSv, P = 0.04), but no difference in costs between the two strategies at 12 months. In the management of patients with suspected CAD, a strategy of initial stress MPI is substantially less likely to require further downstream testing than initial testing with CCTA. Trial registration: clinicaltrials.gov identification number NCT01368770.

• الناشر: Elsevier Inc,Springer US,Springer Nature B.V
• موضوع: Cardiology / Cardiovascular disease / computed tomography / Computed Tomography Angiography - methods / Coronary Angiography - methods / coronary artery disease / Coronary Artery Disease - diagnostic imaging / Coronary Artery Disease - pathology / Coronary vessels / Early Diagnosis / Electrocardiography / Female / Heart Function Tests - methods / Humans / Imaging / Internationality / Male / Mass Screening - methods / Medicine / Medicine & Public Health / Middle Aged / Myocardial Perfusion Imaging - methods / Myocardial perfusion imaging—SPECT / NCT / NCT01368770 / Nuclear Medicine / Observer Variation / Original / Original Article / Radiology / Reproducibility of Results / Sensitivity and Specificity / Tomography