Key result
Ischemia severity on stress testing was weakly associated with the anatomic extent and severity of coronary artery disease on computed tomography angiography (r=0.27).
Why the study?
The relationship between stress-induced ischemia and anatomic CAD extent and severity is multifactorial and needed investigation among patients with chronic coronary disease across different stress test modalities.
Does ischemia severity on stress testing correlate with the anatomic extent of CAD on CCTA in patients with chronic coronary disease?
RCT (n=3,601)
Yes
Does ischemia severity on stress testing correlate with the anatomic extent of CAD on CCTA in patients with chronic coronary disease?
Effect estimate: r=0.27
Ischemia severity on stress testing has only a weak to moderate correlation with the anatomic extent of CAD on CCTA in patients with chronic coronary disease.
Modest ischemia-CAD correlation on stress testing and CCTA warrants integrated interpretation in chronic disease; leaves open optimal multimodality strategies.
BACKGROUND: The relationship between the extent and severity of stress-induced ischemia and the extent and severity of anatomic coronary artery disease (CAD) in patients with obstructive CAD is multifactorial and includes the intensity of stress achieved, type of testing used, presence and extent of prior infarction, collateral blood flow, plaque characteristics, microvascular disease, coronary vasomotor tone, and genetic factors. Among chronic coronary disease participants with site-determined moderate or severe ischemia, we investigated associations between ischemia severity on stress testing and the extent of CAD on coronary computed tomography angiography. METHODS: Clinically indicated stress testing included nuclear imaging, echocardiography, cardiac magnetic resonance imaging, or nonimaging exercise tolerance test. Among those with preserved renal function who underwent coronary computed tomography angiography, we examined relationships between ischemia and CAD by coronary computed tomography angiography, overall, and by stress test modality, regardless of subsequent randomization. Core laboratories categorized ischemia as severe, moderate, mild, or none, while the extent and severity of anatomic CAD were categorized based on the modified Duke prognostic index. RESULTS: Among 3601 participants with interpretable stress tests and coronary computed tomography angiography, ischemia severity was weakly associated with CAD extent/severity (r=0.27), with modest variability in strength of association by modality: nuclear (n=1532; r=0.40), echocardiography (n=827; r=0.15), cardiac magnetic resonance imaging (n=108; r=0.31), and exercise tolerance test (n=1134; r=0.18). The extent of infarction on nuclear imaging and echocardiography was weakly associated with CAD extent/severity. CONCLUSIONS: Overall, ischemia severity on stress testing showed weak to moderate associations with the anatomic extent of CAD in this cohort with moderate or severe ischemia on local interpretation and controlled symptoms. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01471522.
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Reynolds et al. (2024) conducted an RCT in Chronic coronary disease with moderate or severe ischemia (n=3,601). Stress testing (nuclear imaging, echocardiography, cardiac magnetic resonance imaging, or exercise tolerance test) was evaluated on Association between ischemia severity on stress testing and extent/severity of anatomic CAD on coronary computed tomography angiography (r=0.27). Ischemia severity on stress testing was weakly associated with the anatomic extent and severity of coronary artery disease on computed tomography angiography (r=0.27).
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