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- Title
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).
- Authors
Karthikeyan, Ganesan; Guzic Salobir, Barbara; Jug, Borut; Devasenapathy, Niveditha; Alexanderson, Erick; Vitola, Joao; Kraft, Otakar; Ozkan, Elgin; Sharma, Saket; Purohit, Gaurav; Dolenc Novak, Maja; Meave, Aloha; Trevethan, Sergio; Cerci, Rodrigo; Zier, Sandra; Gotthardtová, Lucia; Jonszta, Tomáš; Altin, Timucin; Soydal, Cigdem; Patel, Chetan
- Abstract
<bold>Objective: </bold>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).<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusion: </bold>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.<bold>Trial Registration: </bold>clinicaltrials.gov identification number NCT01368770.
- Subjects
CORONARY artery abnormalities; MYOCARDIAL perfusion imaging; COMPUTED tomography; DISEASE management; CLINICAL trials; COMPARATIVE studies; CORONARY disease; HEART function tests; INTERNATIONAL relations; RESEARCH methodology; MEDICAL cooperation; MEDICAL screening; RESEARCH; RESEARCH evaluation; EVALUATION research; RANDOMIZED controlled trials; RESEARCH bias; EARLY diagnosis; CORONARY angiography
- Publication
Journal of Nuclear Cardiology, 2017, Vol 24, Issue 2, p507
- ISSN
1071-3581
- Publication type
journal article
- DOI
10.1007/s12350-016-0664-3