Key result
Coronary stenosis under 70% on CCTA yields no focal perfusion abnormalities on follow-up MPI.
Why the study?
There is limited evidence on the clinical value of performing follow-up cardiac nuclear myocardial perfusion imaging in patients with chest pain after undergoing CCTA.
Does follow-up cardiac nuclear stress perfusion imaging provide clinical value in patients with chest pain and non-critical coronary artery stenosis on CCTA?
Observational (n=100)
Does follow-up cardiac nuclear stress perfusion imaging provide clinical value in patients with chest pain and non-critical coronary artery stenosis on CCTA?
Follow-up cardiac nuclear perfusion imaging has limited clinical value in low-to-intermediate risk chest pain patients with less than 70% coronary stenosis on CCTA.
Supports deferring nuclear perfusion imaging after CCTA <70% stenosis; hypothesis-generating, requires prospective confirmation.
BACKGROUND: Clinical workup for chest pain varies among institutions. Acute coronary syndrome (ACS) is the primary diagnosis to rule out in the differential diagnosis, due to its associated mortality and morbidity. Although studies have demonstrated efficacy of coronary computed tomographic angiography (CCTA) in diagnosis obstructive coronary artery disease (CAD), there is limited evidence in the clinical value of performing cardiac nuclear stress perfusion imaging [myocardial perfusion imaging (MPI)] exam in patients with chest pain after undergoing CCTA. We aim to evaluate clinical value of follow-up nuclear cardiac MPI in patients with chest pain who have undergone recent CCTA. METHODS: A total of 1,000 patients were evaluated in this IRB approved retrospective study who presented with symptoms of ACS. Patients who had elevated troponin or abnormal electrocardiogram (ECG) findings at initial presentation or prior to cardiac nuclear MPI were excluded from the study. All patients who underwent 64- or 320-detector row ECG-gated CCTA as well as a follow-up nuclear MPI. Patients who had diagnostics studies limited by artifact [e.g., suboptimal intravenous (IV) contrast bolus in CCTA, motion artifact on CCTA or MPI, etc.] were excluded. RESULTS: One hundred patients met the inclusion criteria. Patient demographics include average age 64.3 [32-89] years, 59 male, 41 females. Ninety-five/100 patients had at least one vessel with 50-70% coronary artery diameter stenosis measured on CCTA. There were no focal perfusion abnormalities identified on cardiac nuclear MPI in patients with less than 70% stenosis diagnosed on CCTA. Five percent of patients were identified with coronary arterial narrowing greater than 70% on CCTA and all 5 of these patients have evidence of abnormal cardiac nuclear stress test (perfusion abnormalities, chest pain, abnormal ECG). CONCLUSIONS: In low-to-intermediate risk patients with chest pain and evidence of non-critical coronary artery stenosis (i.e., less than 70% stenosis) diagnosed on CCTA, a follow-up cardiac nuclear perfusion imaging is of limited value.
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Gul et al. (2020) conducted an observational in Chest pain with suspected acute coronary syndrome (n=100). Cardiac nuclear stress perfusion imaging (MPI) after CCTA was evaluated on Focal perfusion abnormalities on cardiac nuclear MPI. Follow-up cardiac nuclear perfusion imaging yielded no focal perfusion abnormalities in all 95 patients with less than 70% coronary stenosis diagnosed on prior CCTA.
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