Baggiano Andrea, Maragna Riccardo, Mushtaq Saima, Annoni Andrea, Berna Giovanni, Cannata Francesco, Del Torto Alberico, Carerj Maria Ludovica, Fazzari Fabio, Formenti Alberto, Frappampina Antonio, Fusini Laura, Junod Daniele, Mancini Maria Elisabetta, Mantegazza Valentina, Marchetti Francesca, Sbordone Francesco Paolo, Tassetti Luigi, Volpe Alessandra, Baessato Francesca, Guglielmo Marco, Rovera Chiara, Rabbat Mark G, Pergola Valeria, Pedrinelli Roberto, Perrone Filardi Pasquale, Guaricci Andrea Igoren, Pepi Mauro, Pontone Gianluca
Centro Cardiologico Monzino IRCCS, Via C. Parea 4, Milan 20138, Italy.
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Eur Heart J Cardiovasc Imaging. 2025 Jun 30;26(7):1140-1149. doi: 10.1093/ehjci/jeaf119.
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.
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.
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.
应力计算机断层扫描灌注成像（Stress-CTP）是一种在冠状动脉计算机断层扫描血管造影（cCTA）基础上增加的功能技术，用于改善冠状动脉疾病（CAD）患者的管理。ROUTINE-CTP注册研究是一项前瞻性研究，旨在评估在现实环境中常规实施联合cCTA加Stress-CTP对评估中高危CAD患者或已知有胸痛症状的CAD患者的影响。
随访期间收集的数据包括辐射暴露、单独cCTA与cCTA联合Stress-CTP之间的重新分类率、后续的非侵入性检查、有创冠状动脉造影（ICA）的转诊率、ICA时非阻塞性CAD的患病率、血运重建率和主要不良心脏事件（MACE）。连续263例患者参与了该研究（平均年龄65±9岁，79%为男性），其中156例（59%）曾接受过血运重建。cCTA和Stress-CTP的可评估率分别为95%和99%。具有功能意义的CAD患者经历了更多的下游有创检查和血运重建（P<0.001），诱发性缺血是血运重建的主要独立预测因素（心率20.08），在阻塞性CAD且无诱发性缺血的患者亚组中未发生冠状动脉相关MACE。
应力CTP时诱发性缺血的存在是冠状动脉血运重建的主要预测因素，而无灌注缺损则允许安全地推迟进一步检查或有创评估。尽管存在阻塞性CAD，但这种方法在识别不良事件风险较低的个体方面显示出更高的诊断率。
