Coronary CT angiography versus myocardial perfusion imaging for near-term quality of life, cost and radiation exposure: a prospective multicenter randomized pilot trial.
BACKGROUND
Clinical outcomes and resource utilization after coronary computed tomography angiography (CTA) versus myocardial perfusion single-photon emission CT (MPS) in patients with stable angina and suspected coronary artery disease (CAD) has not been examined.


OBJECTIVE
We determined the near-term clinical effect and resource utilization after cardiac CTA compared with MPS.


METHODS
We randomly assigned 180 patients (age, 57.3 ± 9.8 years; 50.6% men) presenting with stable chest pain and suspected CAD at 2 sites to initial diagnostic evaluation by coronary CTA (n = 91) or MPS (n = 89). The primary outcome was near-term angina-specific health status; the secondary outcomes were incident medical and invasive treatments for CAD, CAD health care costs, and estimated radiation dose.


RESULTS
No patients experienced myocardial infarction or death with 98.3% follow-up at 55 ± 34 days. Both arms experienced comparable improvements in angina-specific health status. Patients who received coronary CTA had increased incident aspirin (22% vs 8%; P = 0.04) and statin (7% vs -3.5%; P = 0.03) use, similar rates of CAD-related hospitalization, invasive coronary angiography, noninvasive cardiac imaging tests, and increased revascularization (8% vs 1%; P = 0.03). Coronary CTA had significantly lower total costs ($781.08 [interquartile range (IQR), $367.80-$4349.48] vs $1214.58 [IQR, $978.02-$1569.40]; P < 0.001) with no difference in induced costs. Coronary CTA had a significantly lower total estimated effective radiation dose (7.4 mSv [IQR, 5.0-14.0 mSv] vs 13.3 mSv [IQR, 13.1-38.0 mSv]; P < 0.0001) with no difference in induced radiation.


CONCLUSIONS
In a pilot randomized controlled trial, patients with stable CAD undergoing coronary CTA and MPS experience comparable improvements in near-term angina-related quality of life. Compared with MPS, coronary CTA evaluation is associated with more aggressive medical therapy, increased coronary revascularization, lower total costs, and lower effective radiation dose.
Heart Institute, Division of Cardiology, Cedars Sinai Medical Center, Los Angeles, CA, USA.
James K
JK
Min
Sunaina
S
Koduru
Allison M
AM
Dunning
Jason H
JH
Cole
Jerome L
JL
Hines
Dawn
D
Greenwell
Cathie
C
Biga
Gayle
G
Fanning
Troy M
TM
LaBounty
Millie
M
Gomez
James M
JM
Horowitz
Martin
M
Hadimitzsky
Jorg
J
Hausleiter
Tracy Q
TQ
Callister
Alan R
AR
Rosanski
Leslee J
LJ
Shaw
Daniel S
DS
Berman
Fay Y
FY
Lin
D000368:Aged; D060050:Angina, Stable / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000191:economics / Q000503:physiopathology / Q000628:therapy; D017023:Coronary Angiography / Q000191:economics* / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000191:economics / Q000503:physiopathology / Q000628:therapy; D003326:Coronary Circulation; D005260:Female; D017048:Health Care Costs; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000191:economics*; D055414:Myocardial Perfusion Imaging / Q000191:economics* / Q000379:methods; D010865:Pilot Projects; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D011829:Radiation Dosage; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000191:economics*; D014481:United States