Coronary computed tomography angiography versus functional testing in a multi-ethnic urban county population

BACKGROUND: The greater positive predictive value of coronary computed tomography angiography (CCTA) relative to myocardial perfusion imaging (MPI) and exercise treadmill stress test (ETT) presents the opportunity to optimize resource utilization in identifying coronary artery disease. This study aims to compare the performance of CCTA with functional testing in an understudied, multi-ethnic urban population. METHODS: This retrospective observational study evaluated patients at Harbor-UCLA Medical Center (Torrance, California, USA) who were referred for invasive coronary angiography (ICA) following positive CCTA, MPI, or ETT from 2012 to 2022. ICA results were reviewed to ascertain the rate of indication for revascularization following CCTA, MPI, and ETT. RESULTS: A total of 224 patients were included (mean age 58.8 ± 9.6 year, 63% male, and greater than 56% ethnic minority). Of the 67 patients with positive CCTA referred for ICA, 49 (73%) had an indication for revascularization. In comparison, of the 116 patients with positive MPI, only 49 (42%) had an indication for revascularization, and of the 41 patients with positive ETT, only 16 (39%) had an indication for revascularization. The adjusted odds of CCTA correctly predicting indication for revascularization versus MPI were 6.34 (95% confidence interval: 2.70, 14.92; P ≤ 0.001). Similar odds were found comparing CCTA and ETT, with adjusted odds ratio of 5.97 (95% confidence interval: 2.09, 16.99, P = 0.008). CONCLUSION: In a multi-ethnic urban population, CCTA provides a greater positive predictive value in the diagnosis of obstructive coronary artery disease than MPI and ETT. These results may help guide the allocation of diagnostic resources in a public, urban hospital.