Background

We compared the long-term outcome of subjects without prior cardiac disease who underwent either vasodilator single-photon emission computed tomography (SPECT) or contrast stress-echocardiography (cSE) for suspected coronary artery disease (CAD).

Methods

Subjects who underwent vasodilator SPECT or cSE between 2008 and 2012 for suspected CAD but no history of cardiac disease were included. We retrospectively compared the association of each method with combined all-cause death and nonfatal myocardial infarction and their positive predictive value (PPV) for angiographically obstructive CAD.

Results

A total of 1,387 subjects were selected: 497 who underwent SPECT and 890 who underwent cSE. During 4 years of mean follow-up there were 78 hard events in the cSE group and 51 in the SPECT group. Event-free survival in subjects testing positive for ischemia, either with SPECT or cSE, was significantly worse both in the overall population and after propensity matching patients. In multivariable analyses, vasodilator SPECT or cSE demonstrated significant stratification capability with an ischemic test doubling (SPECT) or more than doubling (cSE) the risk of future hard events independently from other variables. PPV of vasodilator SPECT for the diagnosis of obstructive CAD was inferior to vasodilator cSE (PPV = 63% vs 89%, respectively; P < .001).

Conclusions

Our study suggests that the associations of vasodilator SPECT or cSE with outcome are comparable, with cSE demonstrating better diagnostic PPV for CAD. The absence of ionizing radiation and anticipated lower costs from higher PPV suggest that vasodilator cSE is a valid alternative to vasodilator SPECT as a gatekeeper in subjects without a prior history of CAD.

中文翻译：

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疑似冠状动脉疾病中血管扩张剂应力单光子发射计算机断层扫描或造影剂超声心动图与硬心脏事件的关系

背景

我们比较了没有先天性心脏病的受试者的长期结局，这些受试者接受了血管扩张剂单光子发射计算机断层扫描（SPECT）或对比应力超声心动图（cSE）治疗可疑冠状动脉疾病（CAD）。

方法

纳入对象在2008年至2012年间因怀疑CAD而接受了血管扩张剂SPECT或cSE治疗，但没有心脏病史。我们回顾性地比较了每种方法与全因死亡和非致命性心肌梗死的结合及其对血管造影阻塞性CAD的积极预测价值（PPV）。

结果

总共选择了1,387名受试者：进行了SPECT的497名和进行了cSE的890名。在平均随访的4年中，cSE组发生了78次硬事件，而SPECT组发生了51次硬事件。无论是总体人群还是倾向匹配的患者，无论是SPECT还是cSE均呈阳性的受试者，其无事件生存率均显着降低。在多变量分析中，血管扩张剂SPECT或cSE表现出显着的分层能力，与其他变量无关，缺血测试加倍（SPECT）或加倍（cSE）以后发生硬事件的风险。诊断阻塞性CAD的血管舒张剂SPECT的PPV不如血管舒张剂cSE（PPV分别为63％和89％；P  <.001）。

结论

我们的研究表明，血管舒张剂SPECT或cSE与结局的关联是可比的，而cSE证明对CAD的诊断性PPV更好。由于没有电离辐射和较高的PPV导致预期的较低成本，这表明在没有CAD既往史的受试者中，血管舒张剂cSE可以作为血管舒张剂SPECT的有效替代品。