Models incorporating clinical factors with stress SPECT results improved diagnostic agreement prediction with AUC increased from 0.54 to 0.72 compared to SPECT alone in adults with suspected CAD.
Observational (n=915)
Yes
Does incorporating clinical factors alongside stress SPECT findings improve the diagnostic prediction of obstructive coronary artery disease on invasive coronary angiography?
Incorporating routine clinical factors alongside stress SPECT findings significantly improves the diagnostic prediction of obstructive coronary artery disease compared to SPECT imaging alone.
Effect estimate: OR 3.18 for nitrates use; OR 2.57 for antiplatelet therapy; OR 2.34 for renal failure; OR 1.78 for type 2 diabetes mellitus; OR 0.50 for female sex; OR 0.72 for smoking; OR 0.95 per kg/m2 for BMI (95% CI Various per variable, e.g. nitrates (1.31–7.73), antiplatelets (1.86–3.56), renal failure (1.43–3.84), diabetes (1.28–2.48), female sex (0.34–0.73))
Absolute Event Rate: 68.2% vs 31.8%
p-value: p=<0.001 for predictive models' improved AUC; other p-values vary per variable
Background Stress single-photon emission computed tomography (SPECT) myocardial perfusion imaging offers a non-invasive alternative for invasive coronary angiography (ICA) in diagnosing coronary artery disease (CAD), however often yields inconclusive results. This study aimed to characterize patterns of agreement and discordance between stress SPECT and ICA, and to evaluate potential risk stratification. Methods We retrospectively analyzed 915 patients with suspected CAD who underwent stress SPECT followed by ICA within three months (enrollment: 2019–2020). Clinical, demographic, and imaging data were extracted from medical records. Variables associated with diagnostic agreement were identified using univariate logistic regression. A predictive model combining SPECT results with clinical variables was developed using backward stepwise logistic regression and evaluated by AUC-ROC. Results Diagnostic agreement between stress SPECT and ICA was observed in 624 patients (68.2%), while 291 patients (31.8%) demonstrated discordant results. Agreement was associated with use of nitrates (OR 3.18, 95% CI 1.31–7.73), antiplatelet therapy (OR 2.57, 95% CI 1.86–3.56), renal failure (OR 2.34, 95% CI 1.43–3.84), and type II diabetes mellitus (OR 1.78, 95% CI 1.28–2.48), whereas female sex (OR 0.50, 95% CI 0.34–0.73), smoking (OR 0.72, 95% CI 0.50–1.03), and higher body mass index (BMI; OR 0.95 per kg/m², 95% CI 0.92–0.99) were associated with disagreement. The final multivariable model included stress SPECT results, sex, BMI, smoking status, serum creatinine, renal failure, type II diabetes mellitus, and use of antiplatelets and nitrates and demonstrated improved discrimination compared with SPECT alone (AUC 0.72 vs. 0.54, p 0.001). Conclusion In this exploratory study, clinical factors were associated with an agreement between stress SPECT and ICA. Incorporating clinical context alongside SPECT findings may help inform risk stratification.
Danon et al. (Thu,) conducted a observational in Adults with suspected coronary artery disease undergoing stress single-photon emission computed tomography followed by invasive coronary angiography within 3 months (n=915). Stress single-photon emission computed tomography (SPECT) myocardial perfusion imaging vs. Invasive coronary angiography (ICA) was evaluated on Diagnostic agreement between stress SPECT and invasive coronary angiography results (positive SPECT/positive ICA or negative SPECT/negative ICA) versus discordance (OR 3.18 for nitrates use; OR 2.57 for antiplatelet therapy; OR 2.34 for renal failure; OR 1.78 for type 2 diabetes mellitus; OR 0.50 for female sex; OR 0.72 for smoking; OR 0.95 per kg/m2 for BMI, 95% CI Various per variable, e.g. nitrates (1.31–7.73), antiplatelets (1.86–3.56), renal failure (1.43–3.84), diabetes (1.28–2.48), female sex (0.34–0.73), p=<0.001 for predictive models' improved AUC; other p-values vary per variable). Models incorporating clinical factors with stress SPECT results improved diagnostic agreement prediction with AUC increased from 0.54 to 0.72 compared to SPECT alone in adults with suspected CAD.
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