Financial and Clinical Outcomes of CT Myocardial Perfusion Imaging and Coronary CT Angiography-guided Versus Coronary CT Angiography-guided Strategy

Overview

Journal Eur Radiol

Specialty Radiology

Date 2023 Jun 7

PMID 37286790

Authors

Xu Dai

Ziting Lan

Runjianya Ling

Yarong Yu

Lihua Yu

Zhigang Lu

Chengxing Shen

Kakuya Kitagawa

Yuehua Li

Wenyi Yang

Jiayin Zhang

Affiliations

Soon will be listed here.

Abstract

Objectives: To compare the financial and clinical outcomes of CT myocardial perfusion imaging (CT-MPI) + coronary CT angiography (CCTA)-guided versus CCTA-guided strategy in patients suspected of chronic coronary syndrome (CCS).

Materials And Methods: This study retrospectively included consecutive patients suspected of CCS and referred for CT-MPI+CCTA-guided and CCTA-guided treatment. The details of medical costs within 3 months after index imaging, including downstream invasive procedures, hospitalization, and medications, were recorded. All patients were followed up for major adverse cardiac events (MACE) at a median time of 22 months.

Results: A total of 1335 patients (559 in the CT-MPI+CCTA group and 776 in the CCTA group) were finally included. In the CT-MPI+CCTA group, 129 patients (23.1%) underwent ICA and 95 patients (17.0%) received revascularization. In the CCTA group, 325 patients (41.9%) underwent ICA whereas 194 patients (25.0%) received revascularization. An addition of CT-MPI in the evaluation strategy remarkably reduced the healthcare expenditure, compared with CCTA-guided strategy (USD 1441.36 vs. USD 232.91, p < 0.001). After adjustment for potential cofounders after inverse probability weighting, the CT-MPI+CCTA strategy was significantly associated with lower medical expenditure [adjusted cost ratio (95% CI) for total costs: 0.77 (0.65-0.91), p < 0.001]. In addition, there was no significant difference regarding the clinical outcome between the two groups (adjusted HR= 0.97; p = 0.878).

Conclusions: CT-MPI+CCTA considerably reduced medical expenditures in patients suspected of CCS, compared to the CCTA strategy alone. Moreover, CT-MPI+CCTA led to a lower rate of invasive procedures with a similar long-term prognosis.

Clinical Relevance Statement: CT myocardial perfusion imaging + coronary CT angiography-guided strategy reduced medical expenditure and invasive procedure rate.

Key Points: • CT-MPI+CCTA strategy yielded significantly lower medical expenditure than did the CCTA strategy alone in patients with suspected CCS. • After adjustment for potential confounders, the CT-MPI+CCTA strategy was significantly associated with lower medical expenditure. • No significant difference was observed regarding the long-term clinical outcome between the two groups.

Citing Articles

Coronary CT angiography alone versus with CT perfusion: a systematic review and meta-analysis assessing approaches for chest pain.

DAscenzo F, Faletti R, Di Pietro G, Improta R, Bruno F, Schoepf U Eur Radiol. 2025; .

PMID: 40055231 DOI: 10.1007/s00330-025-11459-7.

References

Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C . 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2019; 41(3):407-477. DOI: 10.1093/eurheartj/ehz425. View

Patel M, Peterson E, Dai D, Brennan J, Redberg R, Anderson H . Low diagnostic yield of elective coronary angiography. N Engl J Med. 2010; 362(10):886-95. PMC: 3920593. DOI: 10.1056/NEJMoa0907272. View

Knuuti J, Ballo H, Juarez-Orozco L, Saraste A, Kolh P, Rutjes A . The performance of non-invasive tests to rule-in and rule-out significant coronary artery stenosis in patients with stable angina: a meta-analysis focused on post-test disease probability. Eur Heart J. 2018; 39(35):3322-3330. DOI: 10.1093/eurheartj/ehy267. View

Yu M, Shen C, Dai X, Lu Z, Wang Y, Lu B . Clinical Outcomes of Dynamic Computed Tomography Myocardial Perfusion Imaging Combined With Coronary Computed Tomography Angiography Versus Coronary Computed Tomography Angiography-Guided Strategy. Circ Cardiovasc Imaging. 2020; 13(1):e009775. DOI: 10.1161/CIRCIMAGING.119.009775. View

Bonow R, Chambers C, Chan P, Dehmer G, Kirtane A, Samuel Wann L . ACCF/SCAI/AATS/AHA/ASE/ASNC/HFSA/HRS/SCCM/SCCT/SCMR/STS 2012 appropriate use criteria for diagnostic catheterization: American College of Cardiology Foundation Appropriate Use Criteria Task Force Society for Cardiovascular Angiography and.... Catheter Cardiovasc Interv. 2012; 80(3):E50-81. DOI: 10.1002/ccd.24467. View

McCaffrey D, Griffin B, Almirall D, Slaughter M, Ramchand R, Burgette L . A tutorial on propensity score estimation for multiple treatments using generalized boosted models. Stat Med. 2013; 32(19):3388-414. PMC: 3710547. DOI: 10.1002/sim.5753. View

Manning W, Basu A, Mullahy J . Generalized modeling approaches to risk adjustment of skewed outcomes data. J Health Econ. 2005; 24(3):465-88. DOI: 10.1016/j.jhealeco.2004.09.011. View

Manning W, Mullahy J . Estimating log models: to transform or not to transform?. J Health Econ. 2001; 20(4):461-94. DOI: 10.1016/s0167-6296(01)00086-8. View

Douglas P, Hoffmann U, Patel M, Mark D, Al-Khalidi H, Cavanaugh B . Outcomes of anatomical versus functional testing for coronary artery disease. N Engl J Med. 2015; 372(14):1291-300. PMC: 4473773. DOI: 10.1056/NEJMoa1415516. View

10.

Kitagawa K, Nakamura S, Ota H, Ogawa R, Shizuka T, Kubo T . Diagnostic Performance of Dynamic Myocardial Perfusion Imaging Using Dual-Source Computed Tomography. J Am Coll Cardiol. 2021; 78(20):1937-1949. DOI: 10.1016/j.jacc.2021.08.067. View

11.

Xu Y, Yu L, Shen C, Lu Z, Zhu X, Zhang J . Prevalence and disease features of myocardial ischemia with non-obstructive coronary arteries: Insights from a dynamic CT myocardial perfusion imaging study. Int J Cardiol. 2021; 334:142-147. DOI: 10.1016/j.ijcard.2021.04.055. View

12.

Douglas P, Pontone G, Hlatky M, Patel M, Norgaard B, Byrne R . Clinical outcomes of fractional flow reserve by computed tomographic angiography-guided diagnostic strategies vs. usual care in patients with suspected coronary artery disease: the prospective longitudinal trial of FFR(CT): outcome and resource.... Eur Heart J. 2015; 36(47):3359-67. PMC: 4677273. DOI: 10.1093/eurheartj/ehv444. View

13.

Hlatky M, De Bruyne B, Pontone G, Patel M, Norgaard B, Byrne R . Quality-of-Life and Economic Outcomes of Assessing Fractional Flow Reserve With Computed Tomography Angiography: PLATFORM. J Am Coll Cardiol. 2015; 66(21):2315-2323. DOI: 10.1016/j.jacc.2015.09.051. View

14.

Curzen N, Nicholas Z, Stuart B, Wilding S, Hill K, Shambrook J . Fractional flow reserve derived from computed tomography coronary angiography in the assessment and management of stable chest pain: the FORECAST randomized trial. Eur Heart J. 2021; 42(37):3844-3852. PMC: 8648068. DOI: 10.1093/eurheartj/ehab444. View

15.

Dai X, Yu Y, Yu L, Zhang L, Zhang J . Design and rationale of randomized CT-PRECISION study. Cardiovasc Diagn Ther. 2021; 11(3):760-767. PMC: 8261741. DOI: 10.21037/cdt-21-57. View

16.

Tebaldi M, Biscaglia S, Fineschi M, Musumeci G, Marchese A, Leone A . Evolving Routine Standards in Invasive Hemodynamic Assessment of Coronary Stenosis: The Nationwide Italian SICI-GISE Cross-Sectional ERIS Study. JACC Cardiovasc Interv. 2018; 11(15):1482-1491. DOI: 10.1016/j.jcin.2018.04.037. View