Costs and Clinical Outcomes after Coronary Multidetector CT Angiography in Patients without Known Coronary Artery Disease: Comparison to Myocardial Perfusion SPECT

Min, James K.; Kang, Ning; Shaw, Leslee J.; Devereux, Richard B.; Robinson, Matthew; Lin, Fay Y.; Legorreta, Antonio P.; Gilmore, Amanda

doi:10.1148/radiol.2483071453

Cited by 82 publications

(55 citation statements)

References 27 publications

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“…The presence of ischemia could be used to classify the patients as having CAD and candidates for receiving aggressive medical therapy and management. Coronary CT angiography has limited accuracy for identifying the physiologic significance of perfusion defects in patients with intermediate or high pre-test likelihood of CAD when compared to MPI SPECT [32]. Thus, MPI SPECT offers additional functional information in the evaluation of coronary stenosis.MPI SPECT can be used as the gatekeeper to invasive coronary angiography.…”

Section: Journal Ofmentioning

confidence: 99%

Cardiac Imaging Modalities in the Diagnosis of Coronary Artery Disease

Sun¹

2013

J Clin Exp Cardiolog

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Coronary artery disease is the leading cause of death in advanced countries. Early detection and diagnosis of coronary artery disease plays an important role in the identification of disease severity and prediction of disease outcome, consequently improving patient management. Diagnosis and management of coronary artery disease is increasingly dependent on less-invasive imaging modalities, including coronary CT angiography, cardiac magnetic resonance imaging, cardiac radionuclide imaging such as SPECT and PET modalities. Rapid developments of these imaging modalities have significantly improved the diagnostic performance of each imaging technique with high diagnostic accuracy achieved in both diagnostic and prognostic value in coronary artery disease. This editorial provides an overview of the diagnostic applications of a variety of less-invasive imaging modalities in the diagnosis of coronary artery disease. This special issue of "Arteriosclerotic Vascular Disease: Part II" in the journal of Clinical and Experimental Cardiology will give particular attention to contributions focusing on the clinical applications of these imaging modalities in the arteriosclerotic vascular disease, in particular, coronary artery disease.

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Section: Journal Ofmentioning

confidence: 99%

Cardiac Imaging Modalities in the Diagnosis of Coronary Artery Disease

Sun¹

2013

J Clin Exp Cardiolog

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“…There is a wealth of economic evidence applying to stress myocardial perfusion SPECT and PET as well as more recent comparative evidence about the value of using CCTA (Table 1) (52)(53)(54)(55)(56). Although earlier reports with decision models explored the cost-effectiveness of a variety of noninvasive tests (57)(58)(59)(60)(61), more recent applications have relied on ''realworld'' data to devise models for comparing the incremental cost-effectiveness of stress myocardial perfusion imaging with that of noninvasive procedures, such as CCTA.…”

Section: Resource Use and Cost-effective Strategiesmentioning

confidence: 99%

“…Reductions in revascularization were recently seen with stress 82 Rb PET (56). An anatomic diagnostic approach with CCTA resulted in even lower revascularization rates than invasive catheterization, yet its rate of PCI or coronary artery bypass surgery was ;2-fold higher than that of stress myocardial perfusion imaging (41,44,45,54,55). It appears that anatomic approaches, either invasive or noninvasive, result in higher rates of revascularization.…”

Section: Resource Use and Cost-effective Strategiesmentioning

confidence: 99%

“…Comparative Cost Savings of CCTA and SPECT Stress myocardial perfusion SPECT was compared with CCTA in 2 reports (54,55). For patients with suspected CAD, the high negative predictive value of CCTA resulted in a more efficient diagnostic pathway, with cost savings of ;$600 for CCTAversus SPECT (55).…”

Section: Incremental Cost-effectiveness Of Stress Spectmentioning

confidence: 99%

“…For patients with suspected CAD, the high negative predictive value of CCTA resulted in a more efficient diagnostic pathway, with cost savings of ;$600 for CCTAversus SPECT (55). For patients with known CAD, the costs of care were $2,451 higher with CCTA than with stress myocardial perfusion SPECT because of repeated invasive angiography after CCTA.…”

Section: Incremental Cost-effectiveness Of Stress Spectmentioning

confidence: 99%

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Risk Assessment and Predictive Value of Coronary Artery Disease Testing

Shaw

Narula²

2009

J Nucl Med

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This review highlights and compares risk assessment, predictive accuracy, and economic outcomes for 3 commonly applied cardiac imaging procedures: stress myocardial perfusion SPECT or PET and coronary CT angiography (CCTA). This review highlights an expansive evidence base for stress myocardial perfusion imaging and reveals a decided advantage for higher-risk patients, notably those who have established coronary artery disease (CAD). It is likely that the use of CCTA will continue to expand, particularly for patients with more atypical symptoms and patients with a lower likelihood of CAD. Despite a high level of evidence, comparative research is not available across modalities that could definitively drive utilization of cardiac imaging modalities. Evi dence about the accuracy of a variety of noninvasive imaging tests for the identification of at-risk patients with known and suspected coronary artery disease (CAD) has been evolving. Most of the early published research on noninvasive cardiology, from the 1980s and early 1990s, focused on the diagnostic accuracy of a test. More recent research has focused on evaluating the ensuing risk in patients with normal and abnormal cardiac imaging findings. Further exploration has been aimed at the graded or directly proportional relationships between the extent and the severity of imaging risk markers and major adverse cardiovascular events. These relationships highlight a common theme throughout the literature of ever-increasing and worsening cardiac event risk with more extensive and severe imaging abnormalities. More recent topics in the prognosis literature are the utility of new technology, such as coronary CT angiography (CCTA), and its accuracy compared with that of conventional testing, such as stress nuclear imaging. For this report, we compare risk assessment, predictive accuracy, and economic outcomes for 3 commonly applied cardiac imaging procedures: stress myocardial perfusion SPECT or PET and CCTA. We further highlight the potential value of hybrid imaging with PET/CT or even sequential imaging with SPECT plus CT. CORRELATION BETWEEN MYOCARDIAL ISCHEMIA AND CORONARY ANATOMYEarly research focused on the accuracy of stress nuclear imaging for detecting obstructive coronary stenosis. Lessons learned from these evaluations were that the detection of obstructive stenosis was related to the severity of the stenosis, collateral flow, and underlying endothelial function. Documentation of high rates of false-positive results (i.e., ischemia with no obstructive CAD) with stress myocardial perfusion may be related to vascular dysfunction, an early marker of atherosclerosis. In addition, normal stress perfusion results in patients with CAD are related to many factors, including collateral blood flow or prior coronary revascularization. It is for these reasons that much of the recent imaging research has focused on risk determination. However, for discussion purposes, it is helpful to understand the relationship between ischemia and coronary anatomy. INDUCIBLE ISCHEMIA D...

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Radiation Dose From Cardiac Computed Tomography Before and After Implementation of Radiation Dose–Reduction Techniques

Raff

Chinnaiyan²,

et al. 2009

JAMA

211

134

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ORONARY ARTERY DISEASE REmains the most frequent cause of death and disability in the developed world and rates are increasing among developing nations. 1 As the population at risk has increased, national health care systems are under financial pressure to deliver cost-effective diagnosis and risk stratification of symptomatic patients suspected of having coronary ischemia. Noninvasive multislice cardiac computed tomography angiography (CCTA) has emerged since 2000 as a new diagnostic test with the potential to efficiently address this challenge. 2,3 Multiple studies of the accuracy of CCTA compared with invasive coronary angiography in thousands of patients have documented sensitivities and negative predictive values in the range of 90%. 4-6 This suggests that CCTA may definitively exclude the diagnosis of coronary artery disease in a substantial proportion of appropriately selected patients, allowing scarce

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Costs and Clinical Outcomes after Coronary Multidetector CT Angiography in Patients without Known Coronary Artery Disease: Comparison to Myocardial Perfusion SPECT

Abstract: Individuals without known CAD who underwent multidetector CT as an initial diagnostic test, compared with those who underwent myocardial perfusion SPECT, incurred lower health care costs with similar rates of myocardial infarction and CAD-related hospitalization.

Cited by 82 publications

References 27 publications

Cardiac Imaging Modalities in the Diagnosis of Coronary Artery Disease

Cardiac Imaging Modalities in the Diagnosis of Coronary Artery Disease

Risk Assessment and Predictive Value of Coronary Artery Disease Testing

Radiation Dose From Cardiac Computed Tomography Before and After Implementation of Radiation Dose–Reduction Techniques

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