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. 2023 Mar 17:10:1087113.
doi: 10.3389/fcvm.2023.1087113. eCollection 2023.

Prognostic value of coronary computed tomography angiography compared to radionuclide myocardial perfusion imaging in patients With coronary stents

Rami M Abazid  1 , Jonathan G Romsa  1 , James C Warrington  1 , Cigdem Akincioglu  1 , Osama A Smettei  1 , Yves Bureau  2   3 , Nikolaos Tzemos  4 , William C Vezina  1
Affiliations

Prognostic value of coronary computed tomography angiography compared to radionuclide myocardial perfusion imaging in patients With coronary stents

Rami M Abazid et al. Front Cardiovasc Med. .

Abstract

Objectives: The aim of this study is to compare the prognostic value of coronary computed tomography angiography (CCTA) with single-photon emission computed tomography (SPECT) in predicting cardiovascular events in patients with stents.

Design: Retrospective analysis.

Setting: University Hospital, London, Ontario Canada.

Participants: Between January 2007 and December 2018, 119 patients post-percutaneous coronary intervention (PCI) who were referred for hybrid imaging with CTA and 2-day rest/stress SPECT were enrolled.

Primary and secondary outcome measures: Patients were followed for any major adverse cardiovascular event (MACE) including: All-cause mortality, Non-fatal myocardial infarction (MI), Unplanned revascularization, Cerebrovascular accident and hospitalization for arrhythmia or heart failure. We define hard cardiac events (HCE) as: cardiac death, non-fatal MI or unplanned revascularization. We used two cut-off values to define obstructive lesions with CCTA ≥50% and ≥70% in any coronary segment. SPECT scan defined as abnormal in the presence of >5% reversible myocardial perfusion defect.

Results: During the follow-up period of 7.2 ± 3.4 years. 45/119 (37.8%) patients experienced 57 MACE: Ten deaths (2 cardiac deaths and 8 of non-cardiac deaths), 29 acute coronary syndrome including non-fatal MI (25 required revascularization), 7 hospitalizations for heart failure, 6 cerebrovascular accidents and 5 new atrial fibrillation. 31 HCEs were reported. Cox regression analysis showed that obstructive coronary stenosis (≥50% and ≥70%) and abnormal SPECT were associated of MACE (p = 0.037, 0.018 and 0.026), respectively. In contrast, HCEs were significantly associated with obstructive coronary stenosis of ≥50% and ≥70% with p = 0.004 and p = 0.007, respectively. In contrast, abnormal SPECT was a nonsignificant predictor of HCEs (p = 0.062).

Conclusion: Obstructive coronary artery stenosis on CCTA can predict MACE and HCE. However, abnormal SPECT can only predict MACE but not HCE in patients post-PCI with a follow-up period of approximately 7 years.

Keywords: computed tomography angiography; percutaneous coronary intervention; prognostic value; single-photon emission computed tomography; stent.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Patient inclusion.
Figure 2
Figure 2
Kaplan-Meier MACE-free survival curves, (A): CCTA coronary stenosis ≥50% stenosis compared to <50% stenosis, (B): CCTA coronary stenosis of greater than 70% versus <70%, and (C): patients with and without revisable ischemia on SPECT.
Figure 3
Figure 3
Kaplan-Meier HCE-free survival curves, (A): CCTA coronary stenosis ≥50% stenosis compared to <50% stenosis, (B): CCTA coronary stenosis of greater than 70% versus <70%, and (C): patients with and without revisable ischemia on SPECT.
See this image and copyright information in PMC

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