Computed tomography coronary angiography versus stress myocardial perfusion imaging for risk stratification in patients with high occupational risk.
OBJECTIVE
To compare the performance of myocardial perfusion imaging (MPI) versus cardiac computed tomographic angiography (CCTA) in patients with a low pretest likelihood of obstructive coronary artery disease and high-risk occupation.


METHODS
We performed a retrospective chart review of all MPI and CCTA studies performed at our institution from January 2006 to May 2008. The primary outcome measure was the incidence of referral to invasive coronary angiography (ICA).


RESULTS
There were 512 MPS and 170 CCTA studies performed during the study period that met the study criteria. The average age was 35±10 for the CCTA arm and 45±5 for the myocardial perfusion scans (MPS) arm, which was statistically significant (P<0.001), with similar sex distribution between the 2 arms (21% female patients in the MPI arm and 20% female patients in the CCTA arm). The incidence of referral to ICA was 15.8% (81/512) after MPS versus 2.4% (4/170) with CCTA (P<0.001). Among patients referred for ICA, the false-positive rate was 93% (75/81) and 50% (2/4) with MPI and CCTA, respectively (P=0.043).


CONCLUSIONS
Compared with MPI, CCTA significantly reduced ICA referral and false-positive noninvasive imaging rates among symptomatic patients with a low probability of coronary artery disease but high occupational risk.
Cardiology Service, Brooke Army Medical Center, San Antonio, TX 78234-6200, USA.
Jennifer
J
Slim
Laudino
L
Castillo-Rojas
Matt
M
Hann
John
J
Symons
Shaun
S
Martinho
Jison
J
Sim
Santiago
S
Jimenez
Brian
B
Haney
Todd C
TC
Villines
Eric A
EA
Shry
Ahmad M
AM
Slim
D000328:Adult; D016009:Chi-Square Distribution; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D009784:Occupational Diseases / Q000000981:diagnostic imaging*; D009790:Occupations; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media