Coronary CT angiography versus myocardial perfusion imaging for near-term quality of life, cost and radiation exposure: A prospective multicenter randomized pilot trial

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• 作者：James K. Min ; Sunaina Koduru ; Allison M. Dunning ; Jason H. Cole ; Jerome L. Hines ; Dawn Greenwell ; Cathie Biga ; Gayle Fanning ; Troy M. LaBounty ; Millie Gomez ; James M. Horowitz ; Martin Hadimitzsky ; Jorg Hausleiter ; Tracy Q. Callister ; Alan R. Rosanski ; Leslee J. Shaw ; Daniel S. Berman ; Fay Y. Lin
• 关键词：Computed tomography ; Myocardial perfusion SPECT ; Randomized trial ; Resource utilization ; Radiation exposure
• 刊名：Journal of Cardiovascular Computed Tomography
• 出版年：2012
• 出版时间：July-August, 2012
• 年：2012
• 卷：6
• 期：4
• 页码：274-283
• 全文大小：317 K

文摘

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Background

Clinical outcomes and resource utilization after coronary computed tomography angiography (CTA) versus myocardial perfusion single-photon emission CT (MPS) in patients with stable angina and suspected coronary artery disease (CAD) has not been examined.

Objective

We determined the near-term clinical effect and resource utilization after cardiac CTA compared with MPS.

Methods

We randomly assigned 180 patients (age, 57.3 ¡À 9.8 years; 50.6 % men) presenting with stable chest pain and suspected CAD at 2 sites to initial diagnostic evaluation by coronary CTA (n?=?91) or MPS (n = 89). The primary outcome was near-term angina-specific health status; the secondary outcomes were incident medical and invasive treatments for CAD, CAD health care costs, and estimated radiation dose.

Results

No patients experienced myocardial infarction or death with 98.3 % follow-up at 55?¡À 34 days. Both arms experienced comparable improvements in angina-specific health status. Patients who received coronary CTA had increased incident aspirin (22 % vs 8 % ; P = 0.04) and statin (7 % vs ?3.5 % ; P = 0.03) use, similar rates of CAD-related hospitalization, invasive coronary angiography, noninvasive cardiac imaging tests, and increased revascularization (8 % vs 1 % ; P = 0.03). Coronary CTA had significantly lower total costs ($781.08 [interquartile range (IQR), $367.80-$4349.48] vs $1214.58 [IQR, $978.02-$1569.40]; P < 0.001) with no difference in induced costs. Coronary CTA had a significantly lower total estimated effective radiation dose (7.4 mSv [IQR, 5.0-14.0 mSv] vs 13.3 mSv [IQR, 13.1-38.0 mSv]; P < 0.0001) with no difference in induced radiation.

Conclusion

In a pilot randomized controlled trial, patients with stable CAD undergoing coronary CTA and MPS experience comparable improvements in near-term angina-related quality of life. Compared with MPS, coronary CTA evaluation is associated with more aggressive medical therapy, increased coronary revascularization, lower total costs, and lower effective radiation dose.