Journal of Cardiovascular Computed Tomography
Volume 3, Issue 4 , Pages 264-271 , July 2009

Rationale and design of a randomized controlled trial comparing stress myocardial perfusion imaging with coronary CT angiography as the initial imaging study for intermediate-risk patients admitted with chest pain

  • Jeffrey M. Levsky, MD, PhD

      Affiliations

    • Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210 Street, Bronx, NY 10467, USA
    • Corresponding Author InformationCorresponding author.
  • ,
  • Mark I. Travin, MD

      Affiliations

    • Department of Nuclear Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210 Street, Bronx, NY 10467, USA
    • Department of Internal Medicine-Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210 Street, Bronx, NY 10467, USA
  • ,
  • Daniel M. Spevack, MD, MS

      Affiliations

    • Department of Internal Medicine-Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210 Street, Bronx, NY 10467, USA
  • ,
  • Mark A. Menegus, MD

      Affiliations

    • Department of Internal Medicine-Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210 Street, Bronx, NY 10467, USA
  • ,
  • Paul W. Huang, MD

      Affiliations

    • Department of Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210 Street, Bronx, NY 10467, USA
  • ,
  • Ythan Goldberg, MD

      Affiliations

    • Department of Internal Medicine-Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210 Street, Bronx, NY 10467, USA
  • ,
  • Elana T. Clark, BA

      Affiliations

    • Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210 Street, Bronx, NY 10467, USA
  • ,
  • Prameela Banoth, MD

      Affiliations

    • Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210 Street, Bronx, NY 10467, USA
    • Department of Internal Medicine-Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210 Street, Bronx, NY 10467, USA
  • ,
  • Katherine D. Freeman, DrPH

      Affiliations

    • Department of Epidemiology and Population Health, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210 Street, Bronx, NY 10467, USA
  • ,
  • Jonathan N. Tobin, PhD

      Affiliations

    • Department of Epidemiology and Population Health, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210 Street, Bronx, NY 10467, USA
    • fClinical Directors Network (CDN), New York, NY, USA
  • ,
  • Linda B. Haramati, MD, MS

      Affiliations

    • Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210 Street, Bronx, NY 10467, USA

Received 12 February 2009 ,Accepted 5 May 2009.

References 

  1. Demaria AN. The growth of diagnostic imaging services. J Am Coll Cardiol. 2005;45:2093–2094
  2. Shekelle PG. Appropriateness criteria: a useful tool for cardiology. Heart. 2009;95:517–520
  3. Shah BR, Patel MR, Peterson ED, Douglas PS. Defining optimal research study design for cardiovascular imaging using computed tomography angiography as a model. Am J Cardiol. 2008;102:943–948
  4. Klocke FJ, Baird MG, Lorell BH, Bateman TM, Messer JV, Berman DS, et al. American College of Cardiology; American Heart Association; American Society for Nuclear Cardiology: ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging–executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging). J Am Coll Cardiol. 2003;42:1318–1333
  5. Brindis RG, Douglas PS, Hendel RC, Peterson ED, Wolk MJ, Allen JM, et al. American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group; American Society of Nuclear Cardiology; American Heart Association. ACCF/ASNC appropriateness criteria for single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI): a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group and the American Society of Nuclear Cardiology endorsed by the American Heart Association. J Am Coll Cardiol. 2005;46:1587–1605
  6. Ward RP, Al-Mallah MH, Grossman GB, Hansen CL, Hendel RC, Kerwin TC, et al. American Society of Nuclear Cardiology: American Society of Nuclear Cardiology review of the ACCF/ASNC appropriateness criteria for single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI). J Nucl Cardiol. 2007;14:e26–e38
  7. Geleijnse ML, Elhendy A, Fioretti PM, Roelandt JR. Dobutamine stress myocardial perfusion imaging. J Am Coll Cardiol. 2000;36:2017–2027
  8. Shaw LJ, Iskandrian AE. Prognostic value of gated myocardial perfusion SPECT. J Nucl Cardiol. 2004;11:171–185
  9. Metz LD, Beattie M, Hom R, Redberg RF, Grady D, Fleischmann KE. The prognostic value of normal exercise myocardial perfusion imaging and exercise echocardiography: a meta-analysis. J Am Coll Cardiol. 2007;49:227–237
  10. Kymes SM, Bruns DE, Shaw LJ, Gillespie KN, Fletcher JW. Anatomy of a meta-analysis: a critical review of exercise echocardiography or exercise SPECT imaging? A meta-analysis of diagnostic test performance. J Nucl Cardiol. 2000;7:599–615
  11. Ambrose JA, Fuster V. The risk of coronary occlusion is not proportional to the prior severity of coronary stenoses. Heart. 1998;79:3–4
  12. Hendel RC, Patel MR, Kramer CM, Poon M, Hendel RC, Carr JC, et al. American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group; American College of Radiology; Society of Cardiovascular Computed Tomography; Society for Cardiovascular Magnetic Resonance; American Society of Nuclear Cardiology; North American Society for Cardiac Imaging; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology: ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology. J Am Coll Cardiol. 2006;48:1475–1497
  13. Mowatt G, Cook JA, Hillis GS, Walker S, Fraser C, Jia X, et al. 64-Slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis. Heart. 2008;94:1386–1393
  14. Hausleiter J, Meyer T, Hadamitzky M, Zankl M, Gerein P, Dörrler K, et al. Non-invasive coronary computed tomographic angiography for patients with suspected coronary artery disease: the Coronary Angiography by Computed Tomography with the Use of a Submillimeter resolution (CACTUS) trial. Eur Heart J. 2007;28:3034–3041
  15. Budoff MJ, Dowe D, Jollis JG, Gitter M, Sutherland J, Halamert E, et al. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol. 2008;52:1724–1732
  16. Miller JM, Rochitte CE, Dewey M, Arbab-Zadeh A, Niinuma H, Gottlieb I, et al. Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med. 2008;359:2324–2336
  17. Meijboom WB, Meijs MF, Schuijf JD, Cramer MJ, Mollet NR, van Mieghem CA, et al. Diagnostic accuracy of 64-slice computed tomography coronary angiography: a prospective, multicenter, multivendor study. J Am Coll Cardiol. 2008;52:2135–2144
  18. Min JK, Shaw LJ, Devereux RB, Okin PM, Weinsaft JW, Russo DJ, et al. Prognostic value of multidetector coronary computed tomographic angiography for prediction of all-cause mortality. J Am Coll Cardiol. 2007;50:1161–1170
  19. Shaw LJ, Berman DS, Hendel RC, Borges Neto S, Min JK, Callister TQ. Prognosis by coronary computed tomographic angiography: matched comparison with myocardial perfusion single-photon emission computed tomography. J Cardiovasc Comput Tomogr. 2008;2:93–101
  20. Ostrom MP, Gopal A, Ahmadi N, Nasir K, Yang E, Kakadiaris I, et al. Mortality incidence and the severity of coronary atherosclerosis assessed by computed tomography angiography. J Am Coll Cardiol. 2008;52:1335–1343
  21. van Werkhoven JM, Schuijf JD, Gaemperli O, Jukema JW, Boersma E, Wijns W, et al. Prognostic value of multislice computed tomography and gated single-photon emission computed tomography in patients with suspected coronary artery disease. J Am Coll Cardiol. 2009;53:623–632
  22. Schoenhagen P. Lesion characteristics and subsequent atherosclerotic disease progression. Insights into the dynamic process of coronary atherosclerosis. Int J Cardiovasc Imaging. 2008;24:429–431
  23. Kantarci M, Ceviz N, Sevimli S, Bayraktutan U, Ceyhan E, Duran C, et al. Diagnostic performance of multidetector computed tomography for detecting aorto-ostial lesions compared with catheter coronary angiography: multidetector computed tomography coronary angiography is superior to catheter angiography in detection of aorto-ostial lesions. J Comput Assist Tomogr. 2007;31:595–599
  24. Thompson RC, Cullom SJ. Issues regarding radiation dosage of cardiac nuclear and radiography procedures. J Nucl Cardiol. 2006;13:19–23
  25. Einstein AJ. Radiation risk from coronary artery disease imaging: how do different diagnostic tests compare?. Heart. 2008;94:1519–1521
  26. Budoff MJ: Maximizing dose reductions with cardiac CT [published online ahead of print December 30, 2008]. Int J Cardiovasc Imaging.
  27. Hacker M, Jakobs T, Matthiesen F, Vollmar C, Nikolaou K, Becker C, et al. Comparison of spiral multidetector CT angiography and myocardial perfusion imaging in the noninvasive detection of functionally relevant coronary artery lesions: first clinical experiences. J Nucl Med. 2005;46:1294–1300
  28. Schuijf JD, Wijns W, Jukema JW, Atsma DE, de Roos A, Lamb HJ, et al. Relationship between noninvasive coronary angiography with multi-slice computed tomography and myocardial perfusion imaging. J Am Coll Cardiol. 2006;48:2508–2514
  29. Hacker M, Jakobs T, Hack N, Nikolaou K, Becker C, von Ziegler F, et al. Sixty-four slice spiral CT angiography does not predict the functional relevance of coronary artery stenoses in patients with stable angina. Eur J Nucl Med Mol Imaging. 2007;34:4–10
  30. Gallagher MJ, Ross MA, Raff GL, Goldstein JA, O'Neill WW, O'Neil B. The diagnostic accuracy of 64-slice computed tomography coronary angiography compared with stress nuclear imaging in emergency department low-risk chest pain patients. Ann Emerg Med. 2007;49:125–136
  31. Gaemperli O, Schepis T, Kalff V, Namdar M, Valenta I, Stefani L, et al. Accuracy of 64-slice CT angiography for the detection of functionally relevant coronary stenoses as assessed with myocardial perfusion SPECT. Eur J Nucl Med Mol Imaging. 2007;34:1162–1171
  32. Nicol ED, Stirrup J, Reyes E, Roughton M, Padley SP, Rubens MB, et al. Sixty-four-slice computed tomography coronary angiography compared with myocardial perfusion scintigraphy for the diagnosis of functionally significant coronary stenoses in patients with a low to intermediate likelihood of coronary artery disease. J Nucl Cardiol. 2008;15:311–318
  33. Gaemperli O, Schepis T, Valenta I, Koepfli P, Husmann L, Scheffel H, et al. Functionally relevant coronary artery disease: comparison of 64-section CT angiography with myocardial perfusion SPECT. Radiology. 2008;248:414–423
  34. Haramati LB, Levsky JM, Jain VR, Altman EJ, Spindola-Franco H, Bobra S, et al. CT angiography for evaluation of coronary artery disease in inner-city outpatients: an initial prospective comparison with stress myocardial perfusion imaging. Int J Cardiovasc Imaging. 2009;25:303–313
  35. Goldstein JA, Gallagher MJ, O'Neill WW, Ross MA, O'Neil BJ, Raff GL. A randomized controlled trial of multi-slice coronary computed tomography for evaluation of acute chest pain. J Am Coll Cardiol. 2007;49:863–871
  36. Chang SA, Choi SI, Choi EK, Kim HK, Jung JW, Chun EJ, et al. Usefulness of 64-slice multidetector computed tomography as an initial diagnostic approach in patients with acute chest pain. Am Heart J. 2008;156:375–383
  37. Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, et al. American College of Cardiology; American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction); American College of Emergency Physicians; Society for Cardiovascular Angiography and Interventions; Society of Thoracic Surgeons; American Association of Cardiovascular and Pulmonary Rehabilitation; Society for Academic Emergency Medicine: ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J Am Coll Cardiol. 2007;50:e1–e157
  38. Kaufmann PA, Gaemperli O. Combining CT and nuclear: a winning hybrid team. J Nucl Cardiol. 2009;16:170–172
  39. Haramati LB. Ethical trials to determine the risks and benefits of radiation exposure from coronary CT angiography. J Am Coll Radiol. 2008;5:1073–1076
  40. Einstein AJ, Henzlova MJ, Rajagopalan S. Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography. JAMA. 2007;298:317–323
  41. Brenner DJ, Hall EJ. Computed tomography–an increasing source of radiation exposure. N Engl J Med. 2007;357:2277–2284
  42. Hansen CL, Goldstein RA, Akinboboye OO, Berman DS, Botvinick EH, Churchwell KB, et al. American Society of Nuclear Cardiology: Myocardial perfusion and function: single photon emission computed tomography. J Nucl Cardiol. 2007;14:e39–e60
  43. Hendel RC, Wackers FJ, Berman DS, Ficaro E, DePuey EG, Klein L, et al. American Society of Nuclear Cardiology: American Society of Nuclear Cardiology consensus statement: reporting of radionuclide myocardial perfusion imaging studies. J Nucl Cardiol. 2006;13:e152–e156
  44. Min JK, Kang N, Shaw LJ, Devereux RB, Robinson M, Lin F, et al. Costs and clinical outcomes after coronary multidetector CT angiography in patients without known coronary artery disease: comparison to myocardial perfusion SPECT. Radiology. 2008;249:62–70
  45. Newhouse JH, Kho D, Rao QA, Starren J. Frequency of serum creatinine changes in the absence of iodinated contrast material: implications for studies of contrast nephrotoxicity. AJR Am J Roentgenol. 2008;191:376–382
  46. El-Hajjar M, Bashir I, Khan M, Min J, Torosoff M, DeLago A. Incidence of contrast-induced nephropathy in patients with chronic renal insufficiency undergoing multidetector computed tomographic angiography treated with preventive measures. Am J Cardiol. 2008;102:353–356

 This study is supported by an AHA Clinical Research Program Grant.

 ClinicalTrials.gov Identifier: NCT 00705458.

 Conflict of interest: The authors report no conflicts of interest.

PII: S1934-5925(09)00159-2

doi: 10.1016/j.jcct.2009.05.006

Journal of Cardiovascular Computed Tomography
Volume 3, Issue 4 , Pages 264-271 , July 2009