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Impact of initial myocardial perfusion imaging versus invasive coronary angiography on outcomes in coronary artery disease: a nationwide cohort study

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

In patients with stable coronary artery disease (CAD), two main options exist to guide management: initial invasive coronary angiography (CAG), or selective CAG after risk stratification using myocardial perfusion imaging (MPI). This study compared clinical outcomes between these two strategies in a large, real-world population.

Methods

The initial cohort comprised 1,000,000 randomly selected patients who had been entered in the National Health Insurance Research Database of Taiwan between 2000 and 2011. Patients with acute coronary syndromes, prior myocardial infarction (MI) or coronary revascularization, and prior treadmill testing or stress echocardiography were excluded. The remaining patients with suspected or known CAD were divided into those in whom initial CAG had been performed and those in whom initial MPI had been performed, and were followed until the end of 2011 for all-cause mortality, MI, and revascularization. A Cox proportional hazards model was used to estimate the risk of events after adjusting for covariates.

Results

The MPI and CAG groups each comprised 4,495 patients after frequency matching, with a similar Charlson comorbidity index (CCI). The MPI group had a significantly and dramatically lower incidence of revascularization (729 vs. 2,380, p < 0.001), MI (268 vs. 1,044, p < 0.001), and all-cause mortality (522 vs. 784, p < 0.001) than the CAG group. Multivariable analysis adjusting for age, gender, CCI, and comorbidities showed that in the MPI group fewer patients had revascularization (HR 0.24, 95% CI 0.22–0.26) and MI (HR 0.23, 95% CI 0.20–0.26), and the rate of all-cause mortality was lower (HR 0.58, 95% CI 0.52–0.64).

Conclusions

In patients with suspected stable CAD, compared with initial invasive CAG, a selective strategy guided by MPI was associated with lower rates of revascularization and MI and improved survival.

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Abbreviations

CAD:

Coronary artery disease

CAG:

Coronary angiography

MPI:

Myocardial perfusion imaging

MI:

Myocardial infarction

CCI:

Charlson comorbidity index

PCI:

Percutaneous coronary intervention

CABG:

Coronary artery bypass grafting

LHID2000:

Longitudinal Health Insurance Database 2000

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Funding

This study was supported in part by the Taiwan Ministry of Health and Welfare Clinical Trial Center (MOHW106-TDU-B-212-113004), China Medical University Hospital, the Academia Sinica Taiwan Biobank Stroke Biosignature Project (BM10601010036), the Taiwan Clinical Trial Consortium for Stroke (MOST 106-2321-B-039-005), the Tseng-Lien Lin Foundation, Taichung, Taiwan, the Taiwan Brain Disease Foundation, Taipei, Taiwan, and Katsuzo and Kiyo AoshimaMemorial Funds, Japan. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. No additional external funding was received for this study.

Author information

Author notes

  1. Guang-Uei Hung and Kuan-Yin Ko contributed equally to this work.

Authors and Affiliations

  1. Department of Nuclear Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan

    Guang-Uei Hung

  2. Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan

    Guang-Uei Hung

  3. Department of Nuclear Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan

    Kuan-Yin Ko & Ruoh-Fang Yen

  4. Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan

    Cheng-Li Lin

  5. College of Medicine, China Medical University, Taichung, Taiwan

    Cheng-Li Lin

  6. Department of Radiology, National Taiwan University College of Medicine, Taipei, Taiwan

    Ruoh-Fang Yen

  7. Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung, 40447, Taiwan

    Chia-Hung Kao

  8. Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan

    Chia-Hung Kao

  9. Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan

    Chia-Hung Kao

Authors
  1. Guang-Uei Hung
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  2. Kuan-Yin Ko
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  3. Cheng-Li Lin
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  4. Ruoh-Fang Yen
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Contributions

Conception/Design: Guang-Uei Hung, Chia-Hung Kao. Provision of study materials: All authors. Collection and/or assembly of data: All authors. Data analysis and interpretation: All authors. Manuscript writing: All authors. Final approval of manuscript: All authors.

Corresponding authors

Correspondence to Ruoh-Fang Yen or Chia-Hung Kao.

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Hung, GU., Ko, KY., Lin, CL. et al. Impact of initial myocardial perfusion imaging versus invasive coronary angiography on outcomes in coronary artery disease: a nationwide cohort study. Eur J Nucl Med Mol Imaging 45, 567–574 (2018). https://doi.org/10.1007/s00259-017-3872-4

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  • DOI: https://doi.org/10.1007/s00259-017-3872-4

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