Resource and OUTcome Impact of routiNE availability of Computed Tomography Perfusion

Le résumé fourni par la source

AIMS: Stress computed tomography perfusion (Stress-CTP) is a functional technique added on top of coronary computed tomography angiography (cCTA) to improve the management of subjects with coronary artery disease (CAD). The ROUTINE-CTP Registry is a prospective study aimed at evaluating the impact of routine implementation of combined cCTA plus Stress-CTP for the assessment of patients with intermediate to high CAD risk or known CAD symptomatic for chest pain in a real-world setting. METHODS AND RESULTS: Data collected during follow-up included radiation exposure, reclassification rates between cCTA alone and cCTA with Stress-CTP, subsequent non-invasive testing, referral rates for invasive coronary angiography (ICA), prevalence of non-obstructive CAD at ICA, rates of revascularization, and major adverse cardiac events (MACE). Two hundred and sixty-three consecutive patients participated in the study (mean age of 65 ± 9 years, 79% male), of whom 156 (59%) had undergone previous revascularization. The evaluability rates for cCTA and Stress-CTP were 95 and 99%, respectively. Patients with functionally significant CAD experienced more downstream invasive testing and revascularization (P < 0.001), inducible ischaemia resulted the main independent predictor of revascularization (heart rate 20.08), and no coronary-related MACE occurred in the subset of patients with obstructive CAD and the absence of inducible ischaemia. CONCLUSION: The presence of inducible ischaemia at stress-CTP resulted the main predictor of coronary revascularization, while the absence of perfusion defects allowed to safely deferred further testing or invasive evaluation. This approach demonstrated a higher diagnostic yield in identifying individuals at lower risk of adverse events despite the presence of obstructive CAD.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.