Radiation dose and positive predictive value of revascularisation with low dose myocardialperfusion scintigraphy compared with computed tomography coronary angiography

Abstract

Background: To evaluate the radiation dose and positive predictive value (PPV) of the need for revascularisation of contemporary (low dose) Myocardial Perfusion Scintigraphy (MPS) compared with Computed Tomography Coronary Angiography (CTCA).Methods: We consecutively reviewed 314 MPS and 221 CTCA studies performed at our hospital in 2013. Stress/Rest MPS studies were performed with exercise and/or adenosine using Sestamibi Tc99m and a solid state Cadmium Zinc Telluride gamma camera. CTCA was performed using a 256 slice CT. Radiation exposure was measured in milisievert (mSv). Positive tests leading to invasive coronary angiography were used to determine the PPV of the need for revascularisation.Results: For demographics see table 1. The main indication for tests in both cohorts was chest pain (>75%). Patients undergoing MPS were older, more likely to have diabetes, and had worse renal function compared with CTCA (p< 0.01).Table 1MPSCTCAP valueAge (years)66.09 ± 43.5353.00 ± 13.79<0.01eGFR73.42 ± 19.2484.04 ± 9.55<0.01Diabetes111/314 (35%)49/221(22%)0.001Radiation (mSv)6.80 ± 2.075.64 ± 3.29<0.01PPV21/41 (51%)21/26 (80%)0.02 Open table in a new tab 41/314 (13%) MPS and 26/221 (11%) CTCA patients proceeded to have coronary angiography. There was a small but statistically significant reduction in radiation dose for CTCA compared with MPS (p< 0.01). CTCA was significantly better at predicting the need for revascularisation compared with MPS (PPV 80% vs 51%, p: 0.02).Conclusions: Despite lower than usual dose MPS utilising contemporary techniques, radiation dose remained lower with CTCA. CTCA had a higher PPV of the need for revascularisation compared with MPS in our non-randomised evaluation. Background: To evaluate the radiation dose and positive predictive value (PPV) of the need for revascularisation of contemporary (low dose) Myocardial Perfusion Scintigraphy (MPS) compared with Computed Tomography Coronary Angiography (CTCA). Methods: We consecutively reviewed 314 MPS and 221 CTCA studies performed at our hospital in 2013. Stress/Rest MPS studies were performed with exercise and/or adenosine using Sestamibi Tc99m and a solid state Cadmium Zinc Telluride gamma camera. CTCA was performed using a 256 slice CT. Radiation exposure was measured in milisievert (mSv). Positive tests leading to invasive coronary angiography were used to determine the PPV of the need for revascularisation. Results: For demographics see table 1. The main indication for tests in both cohorts was chest pain (>75%). Patients undergoing MPS were older, more likely to have diabetes, and had worse renal function compared with CTCA (p< 0.01). 41/314 (13%) MPS and 26/221 (11%) CTCA patients proceeded to have coronary angiography. There was a small but statistically significant reduction in radiation dose for CTCA compared with MPS (p< 0.01). CTCA was significantly better at predicting the need for revascularisation compared with MPS (PPV 80% vs 51%, p: 0.02). Conclusions: Despite lower than usual dose MPS utilising contemporary techniques, radiation dose remained lower with CTCA. CTCA had a higher PPV of the need for revascularisation compared with MPS in our non-randomised evaluation. CSANZ NZ AbstractsHeart, Lung and CirculationVol. 23Preview Full-Text PDF