Radiology Medical News about coronary CT angiography, myocardial perfusion imaging, conventional coronary angiography, coronary artery disease

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Coronary CT angiography and myocardial perfusion imaging to detect flow-limiting stenoses: A potential gatekeeper for coronary revascularization?
European Heart Journal, 08/20/09

Gaemperli O et al. – The combined non-invasive approach coronary CT angiography (CTA)/myocardial perfusion imaging (MPI) has an excellent accuracy to detect flow-limiting coronary stenoses vs quantitative coronary angiography (QCA)/MPI. Revascularization procedures may largely redundant with use of CTA/MPI as a gatekeeper.

Methods

Study of the diagnostic accuracy of a combined non-invasive assessment of coronary artery disease with CTA and MPI for the detection of flow-limiting coronary stenoses and its potential as a gatekeeper for invasive examination and treatment
Subjects: 78 pts (mean age 65 ± 9 yrs) referred for coronary angiography (CA)
Additional CTA and MPI (by single-photon emission-computed tomography) performed
Comparison of detection of flow-limiting stenoses (justifying revascularization) by combination CTA/MPI vs combination QCA/MPI as standard of reference

Results

Findings of both combinations related to the treatment strategy (revascularization vs medical treatment) in catheterization laboratory based on CA findings
Sensitivity, specificity, positive and negative predictive value, and accuracy of CTA/MPI for detection of flow-limiting coronary stenoses: 100% each
Not associated with ischemia on MPI: >50% of revascularization procedures (21/40, 53%) in pts without flow-limiting stenoses and 76% (47/62) of revascularized vessels

Exclusive Author Commentary
Oliver Gaemperli, Philipp A Kaufmann, 08/24/09

"Although widely used, invasive coronary angiography poses a significant risk from procedure-related complications to the patient. Hybrid cardiac imaging (combining myocardial perfusion imaging with SPECT and coronary CT angiography) allows a comprehensive and - equally important - noninvasive assessment of morphology and function and helps to identify flow-limiting lesions that justify an invasive revascularization procedure. Our results show that a large proportion of revascularized patients had no flow-limiting lesions, a finding that is not uncommon across cath labs in Europe and the United States. The use of a hybrid noninvasive approach would have potentionally prevented an invasive procedure in more than half of revascularized patients and roughly three quarters of revascularized coronary arteries, thereby avoiding the risks of an invasive procedure with questionable benefit for the patient. "

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