Abstract 16903: Prognostic Value of Combined CT Angiography and Myocardial Perfusion Imaging vs. Invasive Coronary Angiography and Nuclear Stress Perfusion Imaging for Predicting Major Adverse Cardiovascular Events - The CORE320 Multicenter Study

Abstract

Background: Noninvasive risk stratification in patients with suspected coronary artery disease (CAD) is critical for implementing appropriate strategies to prevent major adverse events (MACE). We aim to compare the survival and accuracy of combined CT angiography (CTA) and CT myocardial stress perfusion imaging (CTP) with combined invasive coronary angiography (ICA) and stress SPECT myocardial perfusion imaging for predicting MACE in patients with suspected CAD. Methods: The CORE320 prospective multicenter study enrolled 381 patients, between 45-85 years of age, who were clinically referred for ICA. Overall, 379 participants had all imaging including coronary CTA, adenosine stress CTP, SPECT and ICA plus complete 2 year follow-up data. An independent panel adjudicated all adverse events. MACE was defined as late revascularization (beyond 30 days of index ICA), myocardial infarction, cardiac death, hospitalization for chest pain or congestive heart failure, and arrhythmia. Kaplan-Meier survival analysis was performed and area under the receiving operating characteristic curve (AUC) was used to determine test accuracy. Results: MACE (45 late revascularizations, 5 myocardial infarctions, 1 cardiac death, 8 hospitalizations for chest pain or congestive heart failure, and 1 arrhythmia) occurred in 51 of 379 patients. The 2 year MACE event free rate for combined CTA/CTP findings was 95% (-) vs. 82% (+) (Figure, p<0.001) and similar to combined ICA/SPECT (p<0.001). Event rates for CTA/CTP vs. ICA/SPECT for either positive or negative results were not significantly different (p=0.126 and p=0.284, respectively). The overall AUC of combined CTA and CTP vs. combined ICA and SPECT for identifying MACE at 2 years was also similar: 68 (95%CI: 62-75) vs. 71 (95%CI: 65-79), respectively, p=0.357. Conclusion: Combined CTA and CTP yields similar prediction of 2 year MACE (especially revascularization) and diagnostic accuracy compared to standard ICA and SPECT.