D'Ascenzo Fabrizio, Faletti Riccardo, Di Pietro Gianluca, Improta Riccardo, Bruno Francesco, Schoepf U Joseph, Di Vita Umberto, Giacobbe Federico, Nebiolo Marco, Siliano Stefano, Solano Andrea, Morena Arianna, Pasinato Elettra, Balducci Marco, Pagliassotto Ilaria, Curà Gaia Cura, Mohamed Mahmoud, Sardella Gennaro, Galea Nicola, Dewey Marc, Francone Marco, Mancone Massimo, Fonio Paolo, De Ferrari Gaetano Maria, De Filippo Ovidio, Gatti Marco
Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital, Turin, Italy.
Department of Radiology, Università degli Studi di Torino, Turin, Italy.
Eur Radiol. 2025 Mar 7. doi: 10.1007/s00330-025-11459-7.
To evaluate the prognostic value of stress Computed Tomography Perfusion (CTP) in patients with suspected or known coronary artery disease.
All studies evaluating patients with chest pain with CTP plus coronary computed tomography angiography (CCTA) alone or versus CCTA were included. The primary analysis included studies comparing CCTA plus CTP vs CCTA alone, while in the secondary analysis we analyzed the incidence of each outcome across all seven studies, two- and single-arm.
Seven double- and single-arm studies were included (two randomized controlled trials and five observational ones) with 3587 patients (2101 evaluated with CTP plus CCTA and 1486 with CCTA alone).In the primary analysis including 4 studies, after a median follow-up of 17 months, the rates of MACEs (OR 1.19, 95% CI 0.91-1.57, p = 0.21) and all-cause death (OR 0.41, 0.11-1.47, p = 0.17) were similar. Patients managed according to CCTA alone had higher rates of total ICA (OR 2.42, 1.99-2.94, p < 0.00001) and ICA without subsequent revascularization (OR 2.85, 1.23-6.61, p = 0.01). Conversely, the rate of ICA with subsequent revascularization was higher in patients who underwent CCTA plus CTP (OR 0.39, 0.22-0.69, p = 0.001). There were no significant differences in terms of recurrent MI (OR 0.94, 0.15-5.83, p = 0.95) and unplanned revascularization (OR 0.69, 0.19-2.51, p = 0.57, all CI 95%) between the two approaches. These results were confirmed in the secondary analysis.
A coronary imaging approach based on perfusion evaluation in addition to anatomic assessment was comparable to CCTA alone in terms of MACE, myocardial infarctions and unplanned revascularizations up to 2 years. Patients evaluated with CTP less frequently underwent ICA, which did, however, result in a higher rate of stent implantation.
Question Does the addition of stress Computed Tomography Perfusion (CTP) to coronary computed tomography angiography (CCTA) improve the diagnostic and prognostic evaluation of patients with chest pain compared to CCTA alone? Findings Stress CTP combined with CCTA reduces unnecessary invasive coronary angiography and increases revascularization rates without significantly impacting MACE, myocardial infarction, or unplanned revascularization. Clinical relevance Incorporating stress CTP into CCTA optimizes care by reducing unnecessary invasive procedures and improving tailored treatment strategies for patients with stable and unstable chest pain.
评估负荷计算机断层扫描灌注成像（CTP）在疑似或已知冠状动脉疾病患者中的预后价值。
纳入所有评估胸痛患者单纯使用CTP联合冠状动脉计算机断层血管造影（CCTA）或与CCTA对比的研究。主要分析包括比较CCTA联合CTP与单纯CCTA的研究，而在次要分析中，我们分析了所有七项双臂和单臂研究中各结局的发生率。
纳入七项双臂和单臂研究（两项随机对照试验和五项观察性研究），共3587例患者（2101例接受CTP联合CCTA评估，1486例仅接受CCTA评估）。在包括4项研究的主要分析中，中位随访17个月后，主要不良心血管事件（MACE）发生率（比值比[OR]1.19，95%置信区间[CI]0.91 - 1.57，p = 0.21）和全因死亡率（OR 0.41，0.11 - 1.47，p = 0.17）相似。仅根据CCTA进行治疗的患者总缺血性冠状动脉事件（ICA）发生率较高（OR 2.42，1.99 - 2.94，p < 0.00001），且后续未进行血运重建的ICA发生率较高（OR 2.85，1.23 - 6.61，p = 0.01）。相反，接受CCTA联合CTP的患者后续进行血运重建的ICA发生率较高（OR 0.39，0.22 - 0.69，p = 0.001）。两种方法在复发性心肌梗死（OR 0.94，0.15 - 5.83，p = 0.95）和非计划性血运重建（OR 0.69，0.19 - 2.51，p = 0.57，所有CI为95%）方面无显著差异。这些结果在次要分析中得到证实。
在长达2年的时间里，基于灌注评估加解剖评估的冠状动脉成像方法在MACE、心肌梗死和非计划性血运重建方面与单纯CCTA相当。接受CTP评估的患者较少进行ICA，但这确实导致了更高的支架植入率。
问题 与单纯冠状动脉计算机断层血管造影（CCTA）相比，在CCTA基础上加用负荷计算机断层扫描灌注成像（CTP）是否能改善胸痛患者的诊断和预后评估？研究结果 负荷CTP联合CCTA可减少不必要的有创冠状动脉造影，并提高血运重建率，而不会显著影响MACE、心肌梗死或非计划性血运重建。临床意义 将负荷CTP纳入CCTA可通过减少不必要的有创操作并改善稳定和不稳定胸痛患者的个体化治疗策略来优化治疗。
