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This Article Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Delbeke, D. Articles by Sandler, M. PubMed Articles by Delbeke, D. Articles by Sandler, M.

Integrated rest/stress myocardial perfusion SPECT (MPS) and 64-slice coronary CTA (CTA): Impact on management in patients with intermediate likelihood of CAD

¹ Vanderbilt Hosp., Nashville, Tennessee; ² Rambam Healthcare, Haifa, Israel

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Objectives: Determine the impact of integrated MPS and CTA on management (mgt) of symptomatic patients (pts) with intermediate likelihood of CAD.

Methods: 71 pts had rest/stress MPS and CTA with an integrated system (Ventri/VCT, GE Healthcare) in 2 hospitals. The impact on mgt was reviewed with this algorithm: the 2nd noninvasive test is performed if the 1st is equivocal and catheterization (cath) is performed if a noninvasive test is definitely abnormal. Potentially avoided invasive cath procedures were determined with this hypothesis: cath would be done when the 1st test is equivocal and the 2nd test was unavailable. The most helpful test was identified by a cardiologist panel with knowledge of clinical data.

Results: 6 and 7 pts would be selected for cath if MPS or CTA was the 1st study respectively. A 2nd test would be performed in 28% and 39% pts if MPS or CTA was the 1st study respectively. Cath would be avoided in 22% and 32% pts if MPS or CTA was the 1st study respectively. If MPS was done 1st, an added CTA to a normal MPS guided towards intensive medical therapy in 32% pts. If CTA was done 1st, no other test was necessary in 60% pts (71% with atypical, 25% with typical symptoms). Either MPS or CTA would have sufficed in 47% pts with atypical symptoms but the combination of both was useful in 75% pts with typical symptoms.

Conclusions: MPS and CTA have complementary roles. Regardless whether MPS or CTA was the 1st study, the same pts were selected for cath except one. Addition of a 2nd noninvasive test avoids invasive procedures in > 20% pts. While in pts with atypical symptoms, CTA 1st may be the best choice, combined MPS/CTA may play a role in mgt decisions in pts with typical symptoms.

This Article Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Delbeke, D. Articles by Sandler, M. PubMed Articles by Delbeke, D. Articles by Sandler, M.