Mengmeng Yu1, Chengxing Shen2, Xu Dai1, Zhigang Lu2, Yining Wang3, Bin Lu4, Jiayin Zhang1. 1. Institute of Diagnostic and Interventional Radiology (M.Y., X.D., J.Z.), Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China. 2. Department of Cardiology (C.S., Z.L.), Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China. 3. Department of Radiology, Peking Union Medical College Hospital (Y.W.), Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China. 4. Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Centre for Cardiovascular Diseases (B.L.), Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Abstract
BACKGROUND:Dynamic computed tomography (CT) myocardial perfusion imaging (MPI) provides quantitative myocardial blood flow for the precise assessment of myocardial ischemia. However, compared with coronary CT angiography (CCTA), whether this functional imaging modality can reduce invasive coronary angiography without revascularization remains unknown. We aimed to determine the clinical outcomes of a dynamic CT-MPI+CCTA-guided versus CCTA-guided strategy in patients with suspected coronary artery disease. METHODS:Consecutive patients with intermediate pretest probability of coronary artery disease were prospectively enrolled and randomized to dynamic CT-MPI+CCTA-guided or CCTA-guided workup. The primary end point was the rate of invasive coronary angiography without revascularization within 3 months. The secondary end point was a composite of major adverse cardiac event at the 3-month, 6-month, and 1-year follow-up. RESULTS: A total of 240 patients (mean age, 69.01±11.2 years; 173 men) were included. The total radiation dose and contrast media usage within 90 days were higher in the CT-MPI+CCTA group than in the CCTA group (10.3 versus 7.1 mSv, P=0.031; 134.5±40.6 versus 108.1±48.2 mL, P<0.0001). Compared with the CCTA-guided group, the CT-MPI+CCTA-guided group had significantly lower rates of invasive coronary angiography within 90 days (48.3% [58/120] versus 30.8% [37/120], P=0.006) and invasive coronary angiography without revascularization (50.0% [29/58] versus 10.8% [4/37], P<0.0001). There were no significant differences regarding the frequency of major adverse cardiac event between the 2 groups at the 3-month, 6-month, and 1-year follow-up. CONCLUSIONS: In patients with intermediate pretest probability of coronary artery disease, CT-MPI+CCTA-guided patient management may be preferred over the CCTA-guided strategy as an approach to reduce unnecessary invasive procedures.
RCT Entities:
BACKGROUND: Dynamic computed tomography (CT) myocardial perfusion imaging (MPI) provides quantitative myocardial blood flow for the precise assessment of myocardial ischemia. However, compared with coronary CT angiography (CCTA), whether this functional imaging modality can reduce invasive coronary angiography without revascularization remains unknown. We aimed to determine the clinical outcomes of a dynamic CT-MPI+CCTA-guided versus CCTA-guided strategy in patients with suspected coronary artery disease. METHODS: Consecutive patients with intermediate pretest probability of coronary artery disease were prospectively enrolled and randomized to dynamic CT-MPI+CCTA-guided or CCTA-guided workup. The primary end point was the rate of invasive coronary angiography without revascularization within 3 months. The secondary end point was a composite of major adverse cardiac event at the 3-month, 6-month, and 1-year follow-up. RESULTS: A total of 240 patients (mean age, 69.01±11.2 years; 173 men) were included. The total radiation dose and contrast media usage within 90 days were higher in the CT-MPI+CCTA group than in the CCTA group (10.3 versus 7.1 mSv, P=0.031; 134.5±40.6 versus 108.1±48.2 mL, P<0.0001). Compared with the CCTA-guided group, the CT-MPI+CCTA-guided group had significantly lower rates of invasive coronary angiography within 90 days (48.3% [58/120] versus 30.8% [37/120], P=0.006) and invasive coronary angiography without revascularization (50.0% [29/58] versus 10.8% [4/37], P<0.0001). There were no significant differences regarding the frequency of major adverse cardiac event between the 2 groups at the 3-month, 6-month, and 1-year follow-up. CONCLUSIONS: In patients with intermediate pretest probability of coronary artery disease, CT-MPI+CCTA-guided patient management may be preferred over the CCTA-guided strategy as an approach to reduce unnecessary invasive procedures.
Authors: Fay M A Nous; Tobias Geisler; Mariusz B P Kruk; Hatem Alkadhi; Kakuya Kitagawa; Rozemarijn Vliegenthart; Michaela M Hell; Jörg Hausleiter; Patricia K Nguyen; Ricardo P J Budde; Konstantin Nikolaou; Cezary Kepka; Robert Manka; Hajime Sakuma; Sachin B Malik; Adriaan Coenen; Felix Zijlstra; Ernst Klotz; Pim van der Harst; Christoph Artzner; Admir Dedic; Francesca Pugliese; Fabian Bamberg; Koen Nieman Journal: JACC Cardiovasc Imaging Date: 2021-09-15