Coronary CT angiography and radionuclide myocardial perfusion imaging (MPI) had similar outcomes in patients admitted with chest pain, a recent study found.
The trial included 400 patients (63% women and 95% ethnic minorities) who were admitted to the telemetry ward of an inner-city medical center with acute chest pain and randomized to either CT angiography or MPI. Results were published online June 9 in Annals of Internal Medicine.
The 2 groups had similar rates of the study's primary outcome, cardiac catheterization not leading to percutaneous or surgical revascularization within 1 year: 15% of the CT patients versus 16% of the MPI patients. (The primary goal of noninvasive coronary imaging was to select patients who may benefit from revascularization and to avoid cardiac catheterization in the remaining patients.) Ten percent of MPI patients did not undergo revascularization, compared to 7.5% of the CT group (hazard ratio, 0.77; 95% CI, 0.40 to 1.49; P=0.44). The CT and MPI patients had similar results on a number of outcomes: length of stay (28.9 vs. 30.4 hours), death (0.5% vs. 3%; P=0.12), nonfatal cardiovascular events (4.5% vs. 4.5%), rehospitalization (43% vs. 49%), ED visits (63% vs. 58%), and outpatient cardiology visits (23% vs. 21%). The CT group did have significantly lower total radiation exposure (24 vs. 29 mSv; P<0.001) and were more likely to grade the experience favorably (P=0.001) and be willing to undergo the examination again (P=0.003).
This study was the first direct comparison of the imaging strategies in this patient population, and showed that the tests did not differ on outcomes or resource utilization, but that CT was associated with less radiation exposure and a more positive patient experience, the study authors concluded. The study's finding of no significant differences in rates of catheterization and percutaneous coronary intervention differs from previous research, the authors noted, suggesting that differing care settings could be partially responsible. The single-center setting limits the generalizability of this study, and decisions to perform cardiac catheterization and revascularization were made clinically without an algorithm, they said.