Hack-Lyoung Kim1, Yong-Jin Kim2, Seung-Pyo Lee3, Eun-Ah Park4, Jin-Chul Paeng5, Hyung-Kwan Kim3, Whal Lee4, Goo-Yeong Cho6, Joo-Hee Zo1, Dong-Ju Choi6, Dae-Won Sohn3. 1. Cardiovascular Center, Seoul National University Boramae Medical Center, Seoul, Korea. 2. Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea kimdamas@snu.ac.kr. 3. Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea. 4. Department of Radiology, Seoul National University Hospital, Seoul, Korea. 5. Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea. 6. Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
Abstract
AIMS: This study was conducted to investigate the incremental prognostic value of sequential use of single-photon emission computed tomography (SPECT) and coronary computed tomography angiography (CCTA) in patients with suspected coronary artery disease (CAD). METHODS AND RESULTS: A total of 1295 patients with suspected CAD who underwent both CCTA and SPECT within 90 days was retrospectively reviewed in three cardiac centres. Cardiovascular events including cardiac death, non-fatal myocardial infarction, unstable angina, and late (> 90 days of imaging tests) revascularization were assessed. During the mean follow-up period of 795 ± 566 days (median, 735 days), there were 109 events (8.4%). Perfusion defect on SPECT and significant stenosis (≥ 50%) on CCTA were independent predictors for events. Sequential use of both imaging tests significantly improved prediction of the cardiovascular events. The incremental prognostic value of SPECT was significant in patients with stenosis of <90% but not in patients with stenosis of ≥ 90% on CCTA. Similarly, the incremental prognostic value of CCTA was significant in patients with the summed stress score (SSS) <4 but not in patients with SSS ≥ 4 on SPECT. CONCLUSIONS: Sequential use of SPECT and CCTA showed an incremental prognostic value in patients with suspected CAD. However, additional benefits were not significant when CCTA revealed stenosis of ≥ 90% or SPECT revealed SSS ≥ 4. These results suggest an effective risk stratification strategy for sequential use of SPECT and CCTA, and maximizing the benefits in these patients. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: This study was conducted to investigate the incremental prognostic value of sequential use of single-photon emission computed tomography (SPECT) and coronary computed tomography angiography (CCTA) in patients with suspected coronary artery disease (CAD). METHODS AND RESULTS: A total of 1295 patients with suspected CAD who underwent both CCTA and SPECT within 90 days was retrospectively reviewed in three cardiac centres. Cardiovascular events including cardiac death, non-fatal myocardial infarction, unstable angina, and late (> 90 days of imaging tests) revascularization were assessed. During the mean follow-up period of 795 ± 566 days (median, 735 days), there were 109 events (8.4%). Perfusion defect on SPECT and significant stenosis (≥ 50%) on CCTA were independent predictors for events. Sequential use of both imaging tests significantly improved prediction of the cardiovascular events. The incremental prognostic value of SPECT was significant in patients with stenosis of <90% but not in patients with stenosis of ≥ 90% on CCTA. Similarly, the incremental prognostic value of CCTA was significant in patients with the summed stress score (SSS) <4 but not in patients with SSS ≥ 4 on SPECT. CONCLUSIONS: Sequential use of SPECT and CCTA showed an incremental prognostic value in patients with suspected CAD. However, additional benefits were not significant when CCTA revealed stenosis of ≥ 90% or SPECT revealed SSS ≥ 4. These results suggest an effective risk stratification strategy for sequential use of SPECT and CCTA, and maximizing the benefits in these patients. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Roel S Driessen; Michiel J Bom; Pepijn A van Diemen; Stefan P Schumacher; Remi M Leonora; Henk Everaars; Albert C van Rossum; Pieter G Raijmakers; Peter M van de Ven; Cornelis C van Kuijk; Adriaan A Lammertsma; Juhani Knuuti; Amir Ahmadi; James K Min; Jonathon A Leipsic; Jagat Narula; Ibrahim Danad; Paul Knaapen Journal: Eur Heart J Cardiovasc Imaging Date: 2020-10-01 Impact factor: 6.875