title: Downstream resource utilization following hybrid cardiac imaging with an integrated cadmium-zinc-telluride/64-slice CT device.
abstract: OBJECTIVE
  Low yield of invasive coronary angiography and unnecessary coronary interventions have been identified as key cost drivers in cardiology for evaluation of coronary artery disease (CAD). This has fuelled the search for noninvasive techniques providing comprehensive functional and anatomical information on coronary lesions. We have evaluated the impact of implementation of a novel hybrid cadmium-zinc-telluride (CZT)/64-slice CT camera into the daily clinical routine on downstream resource utilization.
  
  
  METHODS
  Sixty-two patients with known or suspected CAD were referred for same-day single-session hybrid evaluation with CZT myocardial perfusion imaging (MPI) and coronary CT angiography (CCTA). Hybrid MPI/CCTA images from the integrated CZT/CT camera served for decision-making towards conservative versus invasive management. Based on the hybrid images patients were classified into those with and those without matched findings. Matched findings were defined as the combination of MPI defect with a stenosis by CCTA in the coronary artery subtending the respective territory. All patients with normal MPI and CCTA as well as those with isolated MPI or CCTA finding or combined but unmatched findings were categorized as "no match".
  
  
  RESULTS
  All 23 patients with a matched finding underwent invasive coronary angiography and 21 (91%) were revascularized. Of the 39 patients with no match, 5 (13%, p < 0.001 vs matched) underwent catheterization and 3 (8%, p < 0.001 vs matched) were revascularized.
  
  
  CONCLUSIONS
  Cardiac hybrid imaging in CAD evaluation has a profound impact on patient management and may contribute to optimal downstream resource utilization.
authors.affiliation: Department of Radiology, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Fiechter
authors.forename: Jelena R
authors.initials: JR
authors.lastname: Ghadri
authors.forename: Mathias
authors.initials: M
authors.lastname: Wolfrum
authors.forename: Silke M
authors.initials: SM
authors.lastname: Kuest
authors.forename: Aju P
authors.initials: AP
authors.lastname: Pazhenkottil
authors.forename: Rene N
authors.initials: RN
authors.lastname: Nkoulou
authors.forename: Bernhard A
authors.initials: BA
authors.lastname: Herzog
authors.forename: Cathérine
authors.initials: C
authors.lastname: Gebhard
authors.forename: Tobias A
authors.initials: TA
authors.lastname: Fuchs
authors.forename: Oliver
authors.initials: O
authors.lastname: Gaemperli
authors.forename: Philipp A
authors.initials: PA
authors.lastname: Kaufmann
mesh_terms: D002104:Cadmium; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D012189:Retrospective Studies; D018511:Systems Integration; D013691:Tellurium; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000295:instrumentation*; D015032:Zinc
chemical_list: C474490:CdZnTe; D002104:Cadmium; D015032:Zinc; D013691:Tellurium