title: Hybrid myocardial perfusion SPECT/CT coronary angiography and invasive coronary angiography in patients with stable angina pectoris lead to similar treatment decisions.
abstract: OBJECTIVE
  To evaluate to what extent treatment decisions for patients with stable angina pectoris can be made based on hybrid myocardial perfusion single-photon emission CT (SPECT) and CT coronary angiography (CCTA). It has been shown that hybrid SPECT/CCTA has good performance in the diagnosis of significant coronary artery disease (CAD). The question remains whether these imaging results lead to similar treatment decisions as compared to standalone SPECT and invasive coronary angiography (CA).
  
  
  METHODS
  We prospectively included 107 patients (mean age 62.8±10.0 years, 69% male) with stable anginal complaints and an intermediate to high pre-test likelihood for CAD. Hybrid SPECT/CCTA was performed prior to CA in all patients. The study outcome was the treatment decision categorised as: no revascularisation, percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Treatment decisions were made by two interventional cardiologists and one cardiothoracic surgeon in two steps: first, based on the results of hybrid SPECT/CCTA; second, based on SPECT and CA.
  
  
  RESULTS
  Revascularisation (PCI or CABG) was indicated in 54 (50%) patients based on SPECT and CA. Percentage agreement of treatment decisions in all patients based on hybrid SPECT/CCTA versus SPECT and CA on the necessity of revascularisation was 92%. Percentage agreement of treatment decisions in patients with matched, unmatched and normal hybrid SPECT/CCTA findings was 95%, 84% and 100%, respectively.
  
  
  CONCLUSIONS
  Panel evaluation shows that patients could be accurately indicated for and deferred from revascularisation based on hybrid SPECT/CCTA.
authors.affiliation: Department of Cardiology, St Antonius Hospital, PO Box 2500, Nieuwegein 3430 EM, The Netherlands. JeroenSchaap01@gmail.com
authors.forename: Jeroen
authors.initials: J
authors.lastname: Schaap
authors.forename: Joris A H
authors.initials: JA
authors.lastname: de Groot
authors.forename: Koen
authors.initials: K
authors.lastname: Nieman
authors.forename: W Bob
authors.initials: WB
authors.lastname: Meijboom
authors.forename: S Matthijs
authors.initials: SM
authors.lastname: Boekholdt
authors.forename: Martijn C
authors.initials: MC
authors.lastname: Post
authors.forename: Jan A S
authors.initials: JA
authors.lastname: Van der Heyden
authors.forename: Thom L
authors.initials: TL
authors.lastname: de Kroon
authors.forename: Benno J W M
authors.initials: BJ
authors.lastname: Rensing
authors.forename: Karel G M
authors.initials: KG
authors.lastname: Moons
authors.forename: J Fred
authors.initials: JF
authors.lastname: Verzijlbergen
mesh_terms: D060050:Angina, Stable / Q000175:diagnosis* / Q000601:surgery; D017023:Coronary Angiography / Q000379:methods*; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D009204:Myocardial Revascularization / Q000379:methods*; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed