September 25, 2015 – Coronary computed tomography angiography (CCTA) and radionuclide stress myocardial perfusion imaging (MPI) did not significantly differ in outcomes when evaluating the management of symptomatic patients suspected of having coronary artery disease (CAD), a recent study¹ found.

While the role of CCTA in the managing symptomatic patients suspected of having coronary artery disease is expanding, prospective-intermediate outcomes are lacking. The authors designed a study to compare CCTA with conventional noninvasive testing. There were 400 patients with acute chest pain (mean age, 57 years); 63% women; 54% Hispanic and 37% African-American; and low socioeconomic status. The primary outcome was cardiac catheterization not leading to revascularization within 1 year and depended on clinical management decisions. Secondary outcomes included length of stay, resource utilization, and patient experience. Safety outcomes included death, major cardiovascular events, and radiation exposure.

The results found 15% of patients who had CCTA and 16% who had MPI underwent cardiac catheterization within 1 year; 7.5% and 10% of these patients did not undergo revascularization hazard ratio. The median follow-up was 40.4 months. For the CCTA and MPI groups, the incidence of death, nonfatal cardiovascular events, rehospitalization, emergency department visit and outpatient cardiology visit did not differ.  Long-term, all-cause radiation exposure was lower for the CCTA group. More patients in the CCTA group graded their experience favorably and would undergo the examination again.

The authors concluded that CCTA and MPI groups did not significantly differ in outcomes or resource utilization over 40 months. Compared with MPI, CCTA was associated with less radiation exposure and with a more positive patient experience.

Image: Volume rendered (A) and maximum intensity projection (B) CT angiogram images from a 48-year-old male demonstrating a high-grade stenosis in the mid segment of the left anterior descending coronary artery. The patient had presented with persistent, intermittent chest pain and a myocardial perfusion image had been equivocal.

Source:

1. Levsky JM, Spevack DM, Travin MI, Menegus MA, et al. Coronary Computed Tomography Angiography Versus Radionuclide Myocardial Perfusion Imaging in Patients With Chest Pain Admitted to Telemetry: A Randomized Trial. Ann Intern Med. 2015 Aug 4;163(3):174-83. doi: 10.7326/M14-2948.
2. Coronary CT Angiography as an Alternativeto Invasive Coronary Angiography. Seshu C. Rao¹ and Randall C. Thompson. www.intechopen.com. http://www.intechopen.com/books/coronary-angiography-advances-in-noninvasive-imaging-approach-for-evaluation-of-coronary-artery-disease/coronary-ct-angiography-as-an-alternative-to-invasive-coronary-angiography.