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).
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).
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DOI：
10.1007/s12350-016-0664-3
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发表时间：
2017-04
期刊：
影响因子：
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通讯作者：
Kashyap R
中科院分区：
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作者：
Karthikeyan G;Guzic Salobir B;Jug B;Devasenapathy N;Alexanderson E;Vitola J;Kraft O;Ozkan E;Sharma S;Purohit G;Dolenc Novak M;Meave A;Trevethan S;Cerci R;Zier S;Gotthardtová L;Jonszta T;Altin T;Soydal C;Patel C;Gulati G;Paez D;Dondi M;Kashyap R
为了检验假设，即在疑似冠状动脉疾病（CAD）患者的初始评价中，负荷心肌灌注成像（MPI）将导致比冠状动脉计算机断层扫描血管造影（CCTA）更少的下游测试。在这项国际随机试验中，中度CAD可能性的轻度症状患者和中度心脏事件风险的无症状患者接受了初始应力-静息MPI或CCTA。主要结局是6个月时的下游无创或有创检测。次要结局包括12个月时的累积有效辐射剂量（ERD）和成本。我们从6个国家的6个中心招募了303例患者（151例MPI和152例CTA）。29%（41/143）的患者初始MPI异常，56%（79/141）的患者初始CCTA异常。较少接受初始应力-静息MPI的患者在6个月时进行进一步下游测试（调整后OR 0.51，95% CI 0.28-0.91，P = 0.023）。MPI的中位累积ERD略有增加（9.6 vs. 8.8 mSv，P = 0.04），但12个月时两种策略的成本无差异。 在疑似CAD患者的管理中，初始应力MPI策略比CCTA初始测试需要进一步下游测试的可能性要小得多。试用注册：clinicaltrials.gov识别号NCT 01368770。本文的在线版本（doi：10.1007/s12350-016-0664-3）包含补充材料，可供授权用户使用。
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. The online version of this article (doi:10.1007/s12350-016-0664-3) contains supplementary material, which is available to authorized users.