The effects of initial tests on long-term events have been unknown.
In this observational retrospective study, we analyzed the effects of initial noninvasive tests by myocardial perfusion imaging (MPI) and computed tomography angiography (CTA) on long-term major adverse cardiac events (MACEs) among patients with suspected coronary artery disease during a median follow-up of 8.1 years (interquartile range: 7.7–8.9).
Sex difference in the rate of abnormal findings on initial tests was observed in both the MPI (female vs. male: 32.6 vs. 55.5%; P<0.0001) and CTA groups (30.6 vs. 47.9%; P<0.0001). Early revascularization in the MPI was significantly lower than that in the CTA (16 vs. 23%; P=0.0005). A total of 109 MACEs (39 of 1830 patients during the original follow-up period and 70 of 616 patients during the extended follow-up period) occurred: 77 MACEs (6.4%) in the MPI group and 32 (5.1%) in the CTA group (adjusted hazard ratio for MPI: 0.78; 95% confidence interval: 0.50–1.23; P=0.29). In the total cohort, the risk-adjusted MACE rate in the females was ∼50% of the males.
The long-term MACE rates did not differ between physician-referred initial tests of MPI and CTA despite a higher frequency of early revascularization in the CTA group. In this extended cohort, female sex was associated with a lower rate of positive findings and a lower MACE rate compared with the male sex.
Departments of aCardiovascular Medicine
bNuclear Medicine, Hokkaido University Graduate School of Medicine
cThe University of Tokyo Hospital, Sapporo
dDepartment of Cardiology, Nihon University Hospital
eDepartment of Diagnostic Imaging and Nuclear Medicine, Tokyo Women’s Medical University
fDepartment of Cardiology, Tokyo Medical University, Tokyo
gDepartment of Cardiovascular Medicine, Kyoto University, Graduate School of Medicine, Kyoto
hSaitama Cardiovascular and Respiratory Center, Saitama
iDepartment of Cardiovascular Medicine, Japan Community Healthcare Organization Sagamino Hospital Cardiovascular Medicine, Sagamino, Japan
Correspondence to Masanao Naya, MD, Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan Tel: +81 117 066 973; fax: +81 117 067 874; e-mail: email@example.com
Received February 22, 2018
Received in revised form April 25, 2018
Accepted April 30, 2018