This systematic review and meta-analysis explored the prognostic role of stress computed tomography perfusion (CTP) in patients with suspected or confirmed coronary artery disease.
Integrating stress CTP with CCTA minimizes redundant invasive coronary angiography and increases revascularization rates without markedly impacting MACE, myocardial infarction, or unplanned revascularization.
This systematic review and meta-analysis explored the prognostic role of stress computed tomography perfusion (CTP) in patients with suspected or confirmed coronary artery disease.
Studies involving the evaluation of chest pain using CTP + coronary computed tomography angiography (CCTA)—either as a standalone approach or compared to CCTA alone—were included. The key analysis focused on the comparison between CCTA + CTP and CCTA alone, while the secondary analysis evaluated the outcomes across all the studies, whether two-arm or single-arm.
In total, 7 studies were incorporated in the analysis—2 randomized controlled trials (RCTs) and 5 observational studies—totaling 3,587 volunteers (2,101 evaluated with CTP + CCTA and 1,486 with CCTA alone). In the primary analysis, which involved 4 studies with a median follow-up of 17 months, no vital differences were noted in major adverse cardiovascular events (MACEs) (odds ratio [OR] 1.19) and all-cause mortality (OR 0.41).
However, those managed with CCTA alone exhibited higher rates of invasive coronary angiography (OR 2.42) and invasive coronary angiography without subsequent revascularization (OR 2.85). In contrast, CCTA + CTP patients had a higher rate of invasive coronary angiography with subsequent revascularization (OR 0.39). No prominent differences in recurrent myocardial infarction (OR 0.94) or unplanned revascularization (OR 0.69) were witnessed between the two groups. These findings were reported to be consistent in the secondary analysis.
A coronary imaging approach incorporating perfusion assessment alongside anatomical evaluation yielded similar outcomes to CCTA alone for MACEs, myocardial infarction, and unplanned revascularizations over 2 years. While patients evaluated with CTP had fewer invasive coronary angiography overall, those who underwent the procedure had a higher likelihood of stent placement.
European Radiology
Coronary CT angiography alone versus with CT perfusion: a systematic review and meta-analysis assessing approaches for chest pain
Fabrizio D'Ascenzo et al.
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