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Feasibility of combined risk stratification with coronary CT angiography and stress myocardial SPECT in patients with chronic coronary artery disease

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Abstract

Objective

To examine the additional prognostic value of coronary CT angiography (CTA) over myocardial perfusion imaging (MPI) in patients with suspected or known coronary artery disease.

Methods

A series of 157 patients (mean age 69 ± 9 years; 76% male; median follow-up 49 months; range 12–82 months) underwent stress MPI with SPECT and coronary CTA within a 6-month interval. Summed stress score (SSS) and summed difference score (SDS) of stress MPI, number of vessels with stenosis, and presence of left main trunk stenosis and high-risk plaques on coronary CTA were examined. Primary endpoints were cardiac death, acute myocardial infarction, or unstable angina requiring revascularization. Secondary endpoints were revascularization > 60 days after the latter imaging test. All patients were followed up for at least 1 year (mean 45 ± 19 months; range 12–82 months).

Results

Nine (6%) patients reached primary endpoints. Cardiac death occurred in 1 (0.6%) patient, myocardial infarction in 5 (3%), and unstable angina requiring hospitalization in 3 (2%). Elective revascularization within 60 days was performed in 31 (20%) patients. Sixteen (10%) patients required revascularization after > 60 days. Primary endpoint event-free survival rates were significantly lower in patients with myocardial ischemia (SDS ≥ 2) and high-risk plaques (HRP), and secondary endpoint event-free survival rates in patients with SSS ≥ 4 and 3VD. In multivariate analysis, Cox proportional hazards regression analysis revealed HRP (HR = 8.02; P = 0.006) and myocardial ischemia (HR = 11.487; P = 0.025) were significant predictors of primary endpoints, and 3VD of secondary endpoints (HR = 4.981; P = 0.008). Combined ischemia and HRP resulted in the significant increase of the model Chi square in prediction of primary end points from ischemia or HRP alone (17.4 vs. 9.41; P = 0.005, 17.4 vs. 9.39; P = 0.005, respectively).

Conclusion

Coronary CT angiography may provide additional prognostic information over MPI.

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Acknowledgements

All authors have no relationships relevant to the contents of this paper to disclose.

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Authors and Affiliations

  1. Department of Radiology, Graduate School of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan

    Tomonari Kiriyama, Yoshimitsu Fukushima, Hiromitsu Hayashi & Shin-ichiro Kumita

  2. Division of Cardiology, Hepatology, Geriatrics, and Integrated Medicine, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan

    Hitoshi Takano

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  1. Tomonari Kiriyama
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  2. Yoshimitsu Fukushima
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  3. Hiromitsu Hayashi
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Correspondence to Tomonari Kiriyama.

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Kiriyama, T., Fukushima, Y., Hayashi, H. et al. Feasibility of combined risk stratification with coronary CT angiography and stress myocardial SPECT in patients with chronic coronary artery disease. Ann Nucl Med 32, 22–33 (2018). https://doi.org/10.1007/s12149-017-1214-z

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  • DOI: https://doi.org/10.1007/s12149-017-1214-z

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