Myocardial perfusion imaging diverts patients from unnecessary, invasive angiography
For patients who have undergone CT angiography due to potential coronary artery disease, myocardial perfusion imaging can help them avoid unnecessary invasive procedures down the line, according to a new multicenter analysis
Coronary CTA is commonly used to rule out obstructive coronary artery disease in those previously deemed low-to-mild risk for the artery-narrowing condition. Some are recommended for further imaging to better assess their status, with invasive coronary angiography a potential solution.
But the question remains: Does MPI provide enough added information to warrant second-line recommendations? Danish cardiologists explored this question on Aug. 27 in the Journal of Cardiovascular Computed Tomography.
After looking at more than 53,000 patients over 10 years, the authors found MPI may have potential as a “gatekeeper” for invasive procedures following coronary CTA.
“Our data indicate that the current strategy of MPI as [a] second-line test in selected patients appears effective as it defers more than 80% of patients from invasive coronary angiography and is associated with low event-rates of myocardial infarction and all-cause mortality, comparable to those observed in patients receiving only medical treatment for their CAD after coronary CTA,” Simon Winther, of Aarhus University Hospital in Denmark, and colleagues wrote.
The researchers identified individuals experiencing angina symptoms who underwent CTA for the first time between January 2008 and December 2017. Of the 53,351 patients, 24% were recommended for additional testing, 3,547 (7%) to myocardial perfusion imaging and 9,135 (17%) for invasive coronary angiography.
After adjusting for patient characteristics and medical treatment, those referred for MPI and ICA both had similar cardiac event rates. And fewer than 1% of patients managed with noninvasive MPI underwent revascularization each year, meaning their symptoms were well-managed via imaging.
“These results indicate that MPI can be used to safely defer [a] patient from ICA after a coronary CTA but validation in prospective trials is needed,” the authors concluded.
Read the full study here.
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.