Hybrid myocardial perfusion SPECT/CT coronary angiography and invasive coronary angiography in patients with stable angina pectoris lead to similar treatment decisions
- Jeroen Schaap1,2,
- Joris A H de Groot3,
- Koen Nieman4,5,
- W Bob Meijboom4,5,
- S Matthijs Boekholdt6,
- Martijn C Post1,
- Jan A S Van der Heyden1,
- Thom L de Kroon7,
- Benno J W M Rensing1,
- Karel G M Moons3,
- J Fred Verzijlbergen2,8
- 1Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
- 2Department of Nuclear Medicine, St Antonius Hospital, Nieuwegein, The Netherlands
- 3Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
- 4Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
- 5Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
- 6Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
- 7Department of Cardio-Thoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
- 8Department of Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Correspondence to Dr Jeroen Schaap, Department of Cardiology, St Antonius Hospital, PO Box 2500, Nieuwegein 3430 EM, The Netherlands;
- Received 17 July 2012
- Revised 24 September 2012
- Accepted 25 September 2012
- Published Online First 19 October 2012
Objectives To evaluate to what extent treatment decisions for patients with stable angina pectoris can be made based on hybrid myocardial perfusion single-photon emission CT (SPECT) and CT coronary angiography (CCTA). It has been shown that hybrid SPECT/CCTA has good performance in the diagnosis of significant coronary artery disease (CAD). The question remains whether these imaging results lead to similar treatment decisions as compared to standalone SPECT and invasive coronary angiography (CA).
Methods We prospectively included 107 patients (mean age 62.8±10.0 years, 69% male) with stable anginal complaints and an intermediate to high pre-test likelihood for CAD. Hybrid SPECT/CCTA was performed prior to CA in all patients. The study outcome was the treatment decision categorised as: no revascularisation, percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Treatment decisions were made by two interventional cardiologists and one cardiothoracic surgeon in two steps: first, based on the results of hybrid SPECT/CCTA; second, based on SPECT and CA.
Results Revascularisation (PCI or CABG) was indicated in 54 (50%) patients based on SPECT and CA. Percentage agreement of treatment decisions in all patients based on hybrid SPECT/CCTA versus SPECT and CA on the necessity of revascularisation was 92%. Percentage agreement of treatment decisions in patients with matched, unmatched and normal hybrid SPECT/CCTA findings was 95%, 84% and 100%, respectively.
Conclusions Panel evaluation shows that patients could be accurately indicated for and deferred from revascularisation based on hybrid SPECT/CCTA.