title: Long-term prognostic value of stress myocardial perfusion imaging and coronary computed tomography angiography: A meta-analysis.
abstract: BACKGROUND
  We conducted a meta-analysis to compare the long-term prognostic value of stress single-photon emission computed tomography myocardial perfusion imaging (MPI) and coronary computed tomography angiography (CCTA) for adverse cardiovascular events in subjects with suspected or known coronary artery disease.
  
  
  RESULTS
  We searched PubMed, Cochrane, Web of Science, and Scopus database between January 2000 and December 2014 for stress MPI and CCTA studies that followed up ≥ 100 subjects for ≥ 2.5 years and provided the unadjusted and/or adjusted hazard ratio (HR) at Cox regression analysis. Summary risk estimates for abnormal perfusion at MPI or ≥ 50% coronary stenosis at CCTA were derived in random effect regression analysis, and causes of heterogeneity were determined in meta-regression analysis. We identified 21 eligible articles (10 MPI and 11 CCTA) including 25,258 participants (13,484 in MPI and 11,774 in CCTA studies) with suspected or known coronary artery disease. Among the included publications, 8 MPI and 8 CCTA studies reported the HR for the occurrence of hard events (death and nonfatal myocardial infarction). The pooled HR was comparable for MPI and CCTA studies. The HR for the occurrence of a combined endpoint including revascularization as event was reported in 4 MPI and 6 CCTA studies. The pooled HR was higher for CCTA compared to MPI (P < .05) also when only MPI and CCTA studies with limited representation of prior CAD were considered.
  
  
  CONCLUSIONS
  The long-term prognostic value of MPI and CCTA for the occurrence of hard events is similar. However, the association between event-free survival and CCTA is higher than MPI when coronary revascularization is included in the endpoint.
authors.affiliation: Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Cantoni
authors.affiliation: Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Green
authors.affiliation: Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy.
authors.forename: Wanda
authors.initials: W
authors.lastname: Acampa
authors.affiliation: Department of Translational Medicine, University Federico II, Naples, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Petretta
authors.affiliation: Department of Translational Medicine, University Federico II, Naples, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Bonaduce
authors.affiliation: IRCCS SDN, Naples, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Salvatore
authors.affiliation: Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy. cuocolo@unina.it.
authors.forename: Alberto
authors.initials: A
authors.lastname: Cuocolo
mesh_terms: D000072226:Computed Tomography Angiography; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D006801:Humans; D055414:Myocardial Perfusion Imaging; D011379:Prognosis
keywords: Myocardial perfusion imaging: SPECT; computed tomography (CT); coronary artery disease; meta-analysis; prognosis