Parlow Simon, Jung Richard G, Di Santo Pietro, Joseph Joanne, Skanes Stephanie, Abdel-Razek Omar, Prosperi-Porta Graeme, Motazedian Pouya, Froeschl Michael, Labinaz Marino, Mathew Rebecca, Ramirez F Daniel, Simard Trevor, Hibbert Benjamin
Division of Critical Care Medicine, University of Ottawa, Ottawa, Ontario, Canada.
CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Mayo Clin Proc Innov Qual Outcomes. 2025 Jan 2;9(1):100589. doi: 10.1016/j.mayocpiqo.2024.100589. eCollection 2025 Feb.
To examine the role of noninvasive testing (NIT) before invasive coronary angiography (ICA) by evaluating the association between a positive myocardial perfusion imaging (MPI) or computed tomography angiography (CTA) result and the decision to perform coronary revascularization.
We screened all patients who received ICA between August 1, 2015, and July 31, 2019, and identified those who received MPI or CTA within the preceding 12 months. We considered MPI to be a positive result if it found moderate or severe ischemia in a specific coronary territory and CTA to be a positive result if it identified a stenosis greater than 50% in any major coronary artery.
Of the 17,181 individual procedures, 2183 were included. Positive CTA had an odds ratio (OR) of 2.68 (95% CI, 1.82-3.94) for revascularization and positive MPI an OR of 1.29 (95% CI, 1.07-1.56). Overall sensitivity for CTA in the prediction of revascularization was 80.4% (95% CI, 75.7%-84.6%), with vessel-level sensitivity ranging from 57.3% (95% CI, 47.5%-66.7%) to 71.8% (95% CI, 65.8%-77.4%). Overall sensitivity of MPI was 48.2% (95% CI, 44.7%-51.7%), with territory-specific sensitivity ranging from 33.7% (95% CI, 29.9%-37.7%) to 36.5% (95% CI, 32.6%-40.6%). Overall specificity for CTA was low, at 39.5% (32.9%-46.3%), but higher when evaluating at the vessel level, ranging from 60.3% (95% CI, 54.5%-66.0%) to 83.5% (95% CI, 79.6%-86.9%). Overall specificity for MPI was 58.1% (95% CI, 54.9%-61.3%), with territory-specific specificity ranging from 78.6% (95% CI, 76.1%-80.9%) to 78.9% (95% CI, 76.5%-81.3%).
In this population of patients referred for ICA, positive CTA was more closely associated with revascularization than MPI. Further studies are necessary to determine the role of NIT before ICA.
通过评估心肌灌注成像（MPI）或计算机断层扫描血管造影（CTA）结果呈阳性与进行冠状动脉血运重建决策之间的关联，探讨侵入性冠状动脉造影（ICA）前无创检测（NIT）的作用。
我们筛选了2015年8月1日至2019年7月31日期间接受ICA的所有患者，并确定了在之前12个月内接受过MPI或CTA检查的患者。如果MPI在特定冠状动脉区域发现中度或重度缺血，则认为其结果为阳性；如果CTA在任何主要冠状动脉中发现狭窄大于50%，则认为其结果为阳性。
在17181例个体检查中，纳入了2183例。CTA结果呈阳性时进行血运重建的比值比（OR）为2.68（95%可信区间[CI]，1.82 - 3.94），MPI结果呈阳性时的OR为1.29（95%CI，1.07 - 1.56）。CTA预测血运重建的总体敏感性为80.4%（（95%CI，75.7% - 84.6%），血管水平的敏感性范围为57.3%（95%CI，47.5% - 66.7%）至71.8%（95%CI，65.8% - 77.4%）。MPI的总体敏感性为48.2%（95%CI，44.7% - 51.7%），特定区域的敏感性范围为33.7%（95%CI，29.9% - 37.7%）至36.5%（95%CI，32.6% - 40.6%）。CTA的总体特异性较低，为39.5%（32.9% - 46.3%），但在血管水平评估时较高，范围为60.3%（95%CI，54.5% - 66.0%）至83.5%（95%CI，79.6% - 86.9%）。MPI的总体特异性为58.1%（95%CI，54.9% - 61.3%），特定区域的特异性范围为78.6%（95%CI，76.1% - 80.9%）至78.9%（95%CI，76.5% - 81.3%）。
在这群接受ICA检查的患者中，CTA结果呈阳性与血运重建的关联比MPI更密切。有必要进行进一步研究以确定ICA前NIT的作用。
