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Long-term events after physician-referred initial tests by myocardial perfusion imaging or computed tomography coronary angiography in patients with suspected coronary artery disease

Naya, Masanaoa; Uemura, Yukaric; Matsumoto, Naoyad; Momose, Mitsurue; Kato, Takaog; Hida, Satoshif; Yamauchi, Takaoi; Nakajima, Takatomoh; Suzuki, Erikob; Tamaki, Nagarab the J-COMPASS Extended Follow-Up Study Group

doi: 10.1097/MCA.0000000000000645
Diagnosis of CAD

Background The effects of initial tests on long-term events have been unknown.

Patients and methods 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).

Results 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.

Conclusion 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: naya@med.hokudai.ac.jp

Received February 22, 2018

Received in revised form April 25, 2018

Accepted April 30, 2018

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.