Comprehensive Cardiac CT With Myocardial Perfusion Imaging Versus Functional Testing in Suspected Coronary Artery Disease

Abstract

In patients with suspected stable CAD, a tiered cardiac CT protocol with dynamic perfusion imaging offers a fast and efficient alternative to functional testing. (Comprehensive Cardiac CT Versus Exercise Testing in Suspected Coronary Artery Disease 2 [CRESCENT2]; NCT02291484).

Is Physiologic Stress Test with Imaging Comparable to Anatomic Examination of Coronary Arteries by Coronary Computed Tomography Angiography to Investigate Coronary Artery Disease? – A Systematic Review and Meta-Analysis

“…All New MI during follow-up period: A significant reduction in the incidence of future MI was noticed in the CCTA arm (115 vs. 156; RR = 0.71, CI = 0.56-0.91; P < .006, I 2 = 0%); this was mainly noted as a reduction in MI in the SCP subgroup patients (80 vs.120; RR = 0.66, CI = 0.50-0.88; P = .004, I 2 = 0%) compared to the ACP subgroup that showed no difference (35 vs. 36; RR = 0.88, CI = 0.54- 1.44; P = .61, I 2 = 0%). The CCTA arm also had significantly reduced MIs compared to ST with imaging (RR = 0.70, CI = 0.54-0.89; P = .004, I 2 = 0%) with no difference compared to ST without imaging (RR = 1.14, CI = 0.35-3.75; P = .83, I 2 = 0%; Figure 4A and 4B) [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. The NNT after CCTA to prevent one MI was 204 and NNT after ICA to prevent one MI was nine.…”

“…reviewed the abstracts and selected 59 articles for a full review. A total of 16 RCTs met the predefined inclusion criteria for qualitative and quantitative analysis comparing CCTA to ST: myocardial perfusion imaging or scan, stress electrocardiogram (bicycle or treadmill), stress echocardiogram, pharmacologic nuclear scan, graded exercise testing, and pharmacologic ST ( Figure 1) [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28].…”

“…CCTA, coronary computed tomography angiography; ST, stress testing; CI, confidence interval. Figure 5A and 5B) [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. We did not include ICA from the SCOT-HEART study as they only reported new or canceled ICA in their manuscript and appendix [23].…”

“…CI = 1.83-5.60; P < .001, I 2 = 0%) and SCP (OR = 2.79, CI = 2.19-3.55; P < .00001, I 2 = 0%) subgroups and in ST with imaging (OR = 2.84, CI = 2.25-3.59; P < .00001, I 2 = 0%) and without imaging (OR = 4.67, CI =1.15-18.91; P = .03, I 2 = 48%;Figure 6Aand 6B)[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28].…”

“…All-cause mortalityCCTA, coronary computed tomography angiography; ST, stress testing.A. ST with imaging vs. ST without imaging[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] B. Acute chest pain (ACP) vs. stable chest pain (SCP)[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] …”