Acceptance of Combined Coronary CT Angiography and Myocardial CT Perfusion versus Conventional Coronary Angiography in Patients with Coronary Stents--Intraindividual Comparison.

Matthias Rief,Marc Dewey,Peter Martus,Sarah Feger,Eva Schönenberger,Michael Laule

doi:10.1371/journal.pone.0136737

Abstract

ObjectivesTo evaluate how well patients with coronary stents accept combined coronary computed tomography angiography (CTA) and myocardial CT perfusion (CTP) compared with conventional coronary angiography (CCA).BackgroundWhile combined CTA and CTP may improve diagnostic accuracy compared with CTA alone, patient acceptance of CTA/CTP remains to be defined.MethodsA total of 90 patients with coronary stents prospectively underwent CTA/CTP (both with contrast agent, CTP with adenosine) and CCA as part of the CARS-320 study. In this group, an intraindividual comparison of patient acceptance of CTA, CTP, and CCA was performed.ResultsCTP was experienced to be significantly more painful than CTA (p<0.001) and was associated with a higher frequency of dyspnea (p<0.001). Comparison of CTA/CTP with CCA revealed no significant differences in terms of pain (p = 0.141) and comfort (p = 0.377). Concern before CTA/CTP and CCA and overall satisfaction were likewise not significantly different (p = 0.097 and p = 0.123, respectively). Nevertheless, about two thirds (n = 60, 68%) preferred CTA/CTP to CCA (p<0.001). Moreover, patients felt less helpless during CTA/CTP than during CCA (p = 0.026). Lack of invasiveness and absence of pain were the most frequently mentioned advantages of CTA/CTP over CCA in our patient population.ConclusionsCCA and combined CTA/CTP are equally well accepted by patients; however, more patients prefer CTA/CTP. CTP was associated with more intense pain than CTA and more frequently caused dyspnea than CTA alone.Trial RegistrationClinicalTrials.gov NCT00967876

Highlights

Percutaneous coronary stent implantation is a widely used treatment option besides medical treatment in patients with stable coronary heart disease [1]
Comparison of computed tomography angiography (CTA)/CT perfusion (CTP) with conventional coronary angiography (CCA) revealed no significant differences in terms of pain (p = 0.141) and comfort (p = 0.377)
Dewey is a consultant to Guerbet and one of the principal investigators of multi-center studies (CORE-64 and 320) on coronary CT angiography sponsored by Toshiba Medical Systems

Summary

Introduction

Percutaneous coronary stent implantation is a widely used treatment option besides medical treatment in patients with stable coronary heart disease [1]. Relevant complications of stenting include coronary in-stent restenosis [2] and neoatherosclerosis [3]. Stress tests are recommended to detect possible in-stent restenosis in symptomatic patients with coronary stents. If the clinical presentation or the stress test points to in-stent stenosis, conventional coronary angiography (CCA) is recommended [4]. Some recent studies have investigated whether the diagnostic accuracy of cardiac CT can be improved by combining CTA with myocardial CT perfusion (CTP) imaging [8,9,10]. The technical feasibility of combined CTA/CTP has been established in earlier studies, while it is still unclear how well this new cardiac CT test is accepted by patients. While combined CTA and CTP may improve diagnostic accuracy compared with CTA alone, patient acceptance of CTA/CTP remains to be defined

Objectives

Results

Conclusion