Abstract Background Coronary artery disease (CAD) remains one of the leading causes of mortality worldwide. Non-invasive tests (NIT) play a key role in diagnosing CAD and assessing the need for revascularisation (1). Purpose Comparison of positive predictive value of three non-invasive tests (coronary computed tomography angiography (CCTA), stress echocardiography (SE) and single-photon emission computed tomography (SPECT)) in predicting obstructive CAD which met the criteria for revascularisation. Methods Retrospective study of all consecutive patients with positive NITs who were referred for elective invasive coronary angiography from January 2024 to August 2025 in a tertiary hospital in Greece. Patients with positive exercise stress test were excluded. Patients’ demographics, risk factors and type of NIT were correlated with the need of revascularization defined as percutaneous coronary intervention or coronary artery bypass grafting. Categorical variables were compared using Pearson’s Chi-square test. Binary logistic regression was used to identify independent predictors of coronary revascularization. Variables who entered the model were only those statistically significant from univariate analysis. IBM SPSS Statistics (v. 26) was used for statistical analysis. Results 524 patients undergoing elective angiography were included (402 males,76.7%) and mean age was 66.8(±SD:10). 270 (51.5%) had obstructive CAD meeting revascularisation criteria. Most common NIT was SPECT (43.7% of all elective catheterization patients), followed by CCTA (30%) and SE (26.3%). Demographics and baseline characteristics are shown in Figure 1. Need for revascularisation was highest among those with positive CCTA findings (58.5%), compared with 48.4% for SPECT and 48.5% for SE. Univariate analysis demonstrated that only positive CCTA was significantly associated with revascularization (p=0.034). Neither SPECT (p=0.593) nor SE (p=0.731) were statistically important. Patients who underwent revascularisation were more likely to be male (p0.001) and have diabetes mellitus (p=0.010), dyslipidemia (p=0.046), known CAD (p=0.036) or peripheral artery disease (PAD) (p=0.006). In multivariate logistic regression, significant independent predictors of revascularization were positive CCTA (OR=1.72,95%CI1.15–2.57,p=0.009), male sex (OR=2.21,95%CI1.43–3.41,p0.001), CAD (OR=1.67,95%CI1.06–2.62,p=0.028), diabetes mellitus (OR=1.76,95%CI1.17–2.65,p=0.007) and PAD (OR=2.61,95%CI1.12–6.06,p=0.025) (Table 1). Conclusion These findings highlight the positive predictive value of CCTA in comparison to SPECT and SE. Male sex, diabetes mellitus, PAD and established CAD were also associated with revascularisation, reflecting their well-established role in disease burden. Overall, these findings support the superior discriminative performance of anatomical imaging with CCTA in identifying patients requiring revascularization in routine clinical practice (2).Figure 1:Baseline characteristicsFor image description, please refer to the figure legend and surrounding text. Table 1:Independent PredictorsFor image description, please refer to the figure legend and surrounding text.
Detsika et al. (Sun,) studied this question.