Utility of Noninvasive Testing Before Invasive Coronary Angiography in the Assessment for Revascularization

Simon Parlow, MD; Richard G. Jung, MD, PhD; Pietro Di Santo, MD; Joanne Joseph, MD; Stephanie Skanes, MD; Omar Abdel-Razek, MD; Graeme Prosperi-Porta, MSc, MD; Pouya Motazedian, MD; Michael Froeschl, MSc, MD; Marino Labinaz, MD; Rebecca Mathew, MD; F. Daniel Ramirez, MSc, MD; Trevor Simard, MD, PhD; Benjamin Hibbert, MD, PhD

Mayo Clinic Proceedings: Innovations, Quality & Outcomes (Feb 2025)

Utility of Noninvasive Testing Before Invasive Coronary Angiography in the Assessment for Revascularization

Simon Parlow, MD,
Richard G. Jung, MD, PhD,
Pietro Di Santo, MD,
Joanne Joseph, MD,
Stephanie Skanes, MD,
Omar Abdel-Razek, MD,
Graeme Prosperi-Porta, MSc, MD,
Pouya Motazedian, MD,
Michael Froeschl, MSc, MD,
Marino Labinaz, MD,
Rebecca Mathew, MD,
F. Daniel Ramirez, MSc, MD,
Trevor Simard, MD, PhD,
Benjamin Hibbert, MD, PhD

Affiliations

Simon Parlow, MD: Division of Critical Care Medicine, University of Ottawa, Ottawa, Ontario, Canada; CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
Richard G. Jung, MD, PhD: CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
Pietro Di Santo, MD: Division of Critical Care Medicine, University of Ottawa, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
Joanne Joseph, MD: Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
Stephanie Skanes, MD: CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
Omar Abdel-Razek, MD: CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
Graeme Prosperi-Porta, MSc, MD: Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
Pouya Motazedian, MD: CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
Michael Froeschl, MSc, MD: CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
Marino Labinaz, MD: CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
Rebecca Mathew, MD: Division of Critical Care Medicine, University of Ottawa, Ottawa, Ontario, Canada; CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
F. Daniel Ramirez, MSc, MD: School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
Trevor Simard, MD, PhD: CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN
Benjamin Hibbert, MD, PhD: CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN; Correspondence: Address to Benjamin Hibbert, MD, PhD, Mayo Clinic, 200 First St. SW, Rochester, MN 55905.

Journal volume & issue: Vol. 9, no. 1
p. 100589

Abstract

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Objective: To examine the role of noninvasive testing (NIT) before invasive coronary angiography (ICA) by evaluating the association between a positive myocardial perfusion imaging (MPI) or computed tomography angiography (CTA) result and the decision to perform coronary revascularization. Patients and Methods: We screened all patients who received ICA between August 1, 2015, and July 31, 2019, and identified those who received MPI or CTA within the preceding 12 months. We considered MPI to be a positive result if it found moderate or severe ischemia in a specific coronary territory and CTA to be a positive result if it identified a stenosis greater than 50% in any major coronary artery. Results: Of the 17,181 individual procedures, 2183 were included. Positive CTA had an odds ratio (OR) of 2.68 (95% CI, 1.82-3.94) for revascularization and positive MPI an OR of 1.29 (95% CI, 1.07-1.56). Overall sensitivity for CTA in the prediction of revascularization was 80.4% (95% CI, 75.7%-84.6%), with vessel-level sensitivity ranging from 57.3% (95% CI, 47.5%-66.7%) to 71.8% (95% CI, 65.8%-77.4%). Overall sensitivity of MPI was 48.2% (95% CI, 44.7%-51.7%), with territory-specific sensitivity ranging from 33.7% (95% CI, 29.9%-37.7%) to 36.5% (95% CI, 32.6%-40.6%). Overall specificity for CTA was low, at 39.5% (32.9%-46.3%), but higher when evaluating at the vessel level, ranging from 60.3% (95% CI, 54.5%-66.0%) to 83.5% (95% CI, 79.6%-86.9%). Overall specificity for MPI was 58.1% (95% CI, 54.9%-61.3%), with territory-specific specificity ranging from 78.6% (95% CI, 76.1%-80.9%) to 78.9% (95% CI, 76.5%-81.3%). Conclusion: In this population of patients referred for ICA, positive CTA was more closely associated with revascularization than MPI. Further studies are necessary to determine the role of NIT before ICA.

Published in Mayo Clinic Proceedings: Innovations, Quality & Outcomes

ISSN: 2542-4548 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Medicine (General)
Website: https://www.journals.elsevier.com/mayo-clinic-proceedings-innovations-quality-and-outcomes/

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