Key result
PET MPI linked to ~11% lower downstream invasive angiography rate versus SPECT.
Why the study?
Does PET MPI reduce downstream invasive coronary angiography compared to SPECT MPI in adults with suspected coronary artery disease?
Observational (n=33,822)
Yes
Does PET MPI reduce downstream invasive coronary angiography compared to SPECT MPI in adults with suspected coronary artery disease?
Relative Risk: 0.89 (95% CI 0.82–0.97)
Absolute Event Rate: 6% vs 6.8%
p-value: p=0.005
PET MPI is associated with fewer downstream invasive coronary angiograms but a higher procedural PCI yield compared to SPECT, suggesting improved patient selection for invasive evaluation.
Methods We performed a retrospective analysis using the TriNetX Research Network. Adults undergoing PET or SPECT MPI without prior coronary revascularization were identified. The primary endpoint was invasive coronary angiography (ICA) within 90 days, with percutaneous coronary intervention (PCI) as a secondary endpoint. Propensity score matching (1:1) was performed to adjust for baseline differences. Results A total of 33,822 propensity-matched patients were included (PET n=16,911; SPECT n=16,911). At 90 days, ICA occurred less frequently after PET compared with SPECT (6.0% vs 6.8%; RR 0.89, 95% CI 0.82-0.97; p=0.005). Conversely, PCI was more frequent following PET (0.9% vs 0.4%; RR 2.00, 95% CI 1.51-2.65; p<0.001), indicating a higher angiography-to-PCI procedural yield. These findings were consistent across sex-based subgroups. Conclusion In a large real-world cohort, PET MPI was associated with fewer downstream invasive coronary angiograms and a higher procedural PCI yield compared with SPECT. These findings suggest that PET may improve selection of patients for invasive evaluation and enhance efficiency of downstream care.
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Tabaja et al. (2026) conducted an observational in Suspected coronary artery disease or chronic coronary syndrome (n=33,822). PET myocardial perfusion imaging vs. SPECT myocardial perfusion imaging was evaluated on Invasive coronary angiography (ICA) within 90 days (RR 0.89, 95% CI 0.82-0.97, p=0.005). PET myocardial perfusion imaging was associated with a lower rate of downstream invasive coronary angiography within 90 days compared with SPECT (6.0% vs 6.8%; RR 0.89), alongside a higher procedural PCI yield.
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