Author + information
- Received September 27, 2018
- Revision received April 9, 2019
- Accepted April 12, 2019
- Published online July 17, 2019.
- Krishna K. Patel, MD, MSca,b,∗ (, )@krishnapatel888@MidAmericaHeart,
- Firas Al Badarin, MDa,b,
- Paul S. Chan, MD, MSca,b,
- John A. Spertus, MD, MPHa,b,
- Staci Courter, MAc,
- Kevin F. Kennedy, MSb,
- James A. Case, PhDc,
- A. Iain McGhie, MDa,b,
- Gary V. Heller, MDd and
- Timothy M. Bateman, MDa,b
- aDepartment of Cardiology, University of Missouri-Kansas City, Kansas City, Missouri
- bDepartment of Cardiology, Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
- cCardiovascular Imaging Technologies, Kansas City, Missiour
- dDepartment of Cardiology, Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey
- ↵∗Address for correspondence:
Dr. Krishna K. Patel, Division of Cardiology, University of Missouri-Kansas City, Saint Luke’s Mid America Heart Institute, 4401 Wornall Road, 9th floor, Kansas City, Missouri 64111.
Objectives This study compared the clinical effectiveness of pharmacologic stress myocardial perfusion imaging (MPI) plus positron emission tomography (PET) with single-photon emission computed tomography (SPECT) in patients with known coronary artery disease (CAD) presenting with symptoms suggestive of ischemia.
Background Although PET MPI has been shown to have higher diagnostic accuracy in detecting hemodynamically significant CAD than SPECT MPI, whether this impacts downstream management has not been formally evaluated in randomized trials.
Methods This study consisted of a single-center trial in which patients with known CAD and suspected ischemia were randomized to undergo PET or attenuation-corrected SPECT MPI between June 2009 and September 2013. Post-test management was at the discretion of the referring physician, and patients were followed for 12 months. The primary endpoint was diagnostic failure, defined as unnecessary angiography (absence of ≥50% stenosis in ≥1 vessel) or additional noninvasive testing within 60 days of the MPI. Secondary endpoints were post-test escalation of antianginal therapy, referral for angiography, coronary revascularization, and health status at 3, 6, and 12 months.
Results A total of 322 patients with an evaluable MPI were randomized (n = 161 in each group). At baseline, 88.8% of patients were receiving aspirin therapy, 76.7% were taking beta-blockers, and 77.3% were taking statin therapy. Diagnostic failure within 60 days occurred in only 7 patients (2.2%) (3 [1.9%] in the PET group and 4 [2.5%] in the SPECT group; p = 0.70). There were no significant differences between the 2 groups in subsequent rates of coronary angiography, coronary revascularization, or health status at 3, 6, and 12 months of follow-up (all p values ≥0.20); however when subjects were stratified by findings on MPI in a post hoc analysis, those with high-risk MPI on PET testing had higher rates of angiography and revascularization on follow-up than those who had SPECT MPI, whereas those undergoing low-risk PET studies had lower rates of both procedures than those undergoing SPECT (interaction between randomized modality ∗high-risk MPI for 12-month catheterization [p = 0.001] and 12-month revascularization [p = 0.09]).
Conclusions In this contemporary cohort of symptomatic CAD patients who were optimally medically managed, there were no discernible differences in rates of diagnostic failure at 60 days, subsequent coronary angiography, revascularization, or patient health status at 1 year between patients evaluated by pharmacologic PET compared with those evaluated by SPECT MPI. Downstream invasive testing rates with PET MPI were more consistent with high-risk features than those with SPECT MPI. (Effectiveness Study of Single Photon Emission Computed Tomography [SPECT] Versus Positron Emission Tomography [PET] Myocardial Perfusion Imaging; NCT00976053)
- myocardial perfusion imaging
- positron emission tomography
- single photon emission computed tomography
Supported by a clinical research grant from Blue Cross Blue Shield of Kansas City. The funding agency had no involvement in the conduct or reporting of the study. Drs. Patel and Al Badarin are supported by the National Heart, Lung, And Blood Institute of the National Institutes of Health award T32HL110837. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr. Spertus has received research support from Abbott Vascular and Novartis; and is a consultant for United Healthcare, Bayer, Janssen, AstraZeneca, and Novartis; and holds equity interest in Health Outcomes Sciences. Dr. Bateman has received research support from Astellas and GE Healthcare; and is a consultant for GE Healthcare; and holds equity interest in Imaging Technologies; and holds intellectual property rights for Imagen Pro/MD/Q/3D software. Dr. Case holds equity interest in Cardiovascular Imaging Technologies and intellectual property rights for Imagen Pro/MD/Q/3D software. Dr. Heller is a medical advisor for Molecular Imaging Services; and is a consultant for GE HealthCare. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 27, 2018.
- Revision received April 9, 2019.
- Accepted April 12, 2019.
- 2019 American College of Cardiology Foundation
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