title: Optimal initial diagnostic strategies for the evaluation of stable angina patients: a multicenter, prospective study on myocardial perfusion imaging, computed tomographic angiography, and coronary angiography.
abstract: BACKGROUND
  For stable patients suspected of having coronary artery disease (CAD), myocardial perfusion imaging (MPI) or computed tomographic angiography (CT) is used for initial evaluation, while coronary angiography (CAG) is used for confirming the diagnosis. The choice of the initial diagnostic test might influence the treatment strategy.
  
  
  RESULTS
  Patients scheduled for MPI, CT, or CAG as the initial diagnostic test were enrolled. The primary and secondary end-points were a major adverse cardiac event (MACE) and revascularization, respectively. Of the 2,878 patients enrolled, 2,825 underwent initial diagnostic tests, and 2,780 were followed up for 1.42±0.49 years. After adjustment for CAD severity, Cox proportional hazard regression analysis showed that the risk of MACE in the MPI and CT groups were similar and significantly less than that in the CAG group (hazard ratio, 0.82 vs. 2.19; 95% confidence interval [CI], 0.43-1.58 vs. 1.40-3.44). Furthermore, the rate of revascularization in the MPI group was less than that of the CT (odds ratio, 1.62; 95% CI, 1.20-2.18) and CAG (odds ratio, 5.36; 95% CI, 4.07-7.05) groups.
  
  
  CONCLUSIONS
  These data indicate that for stable patients with suspected CAD, the use of MPI or CT as the initial diagnostic test was associated with better prognosis than the use of CAG, and that initial evaluation with MPI was associated with a lower requirement of coronary intervention.
authors.affiliation: Department of Cardiovascular Medicine, Sagamino Social Insurance Hospital, Sagamihara, Japan. t-yamauci@sagaminohp.jp
authors.forename: Takao
authors.initials: T
authors.lastname: Yamauchi
authors.forename: Nagara
authors.initials: N
authors.lastname: Tamaki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kasanuki
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
authors.forename: Yukari
authors.initials: Y
authors.lastname: Uemura
authors.forename: Satoshi
authors.initials: S
authors.lastname: Iimuro
mesh_terms: D000368:Aged; D060050:Angina, Stable / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D017023:Coronary Angiography / Q000379:methods*; D003326:Coronary Circulation; D018450:Disease Progression; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D009204:Myocardial Revascularization; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed