They compared the invasive and noninvasive approaches in 379 patients who were referred for ICA from November 2009 to July 2011. The researchers looked at the ability of both techniques to predict whether or not a future major adverse cardiac event (MACE), such as a heart attack, revascularization, arrhythmia or hospitalization for chest pain or congestive heart failure would occur.

Fifty-one patients, or 13.5 percent, experienced one or more major adverse cardiac events, including 49 revascularizations, five myocardial infarctions, one cardiac death, nine hospitalizations for chest pain or congestive heart failure, and one arrhythmia.

Both techniques proved to have similarly high values for predicting MACE at two years after presentation and event-free survival. The two-year MACE-free rates for combined CT angiography and CT perfusion findings were 94 percent negative for coronary artery disease (CAD) versus 82 percent positive for CAD and were similar to combined ICA/SPECT findings (93 percent negative for CAD vs. 77 percent positive for CAD).
“The key finding of our study is that both techniques are equally effective in identifying which patients are going to have trouble down the road,” Dr. Lima said. “The noninvasive option should be a preferred or at least strongly considered option by cardiologists and radiologists managing these patients because it is safer and less expensive, and patients like it better.”

Obstacles remain before the noninvasive approach can achieve more widespread use, including the lack of a reimbursement code for stress CT perfusion. But the study indicates that the technique is relatively easy to incorporate into existing practices: 15 of the 16 centers in the trial had never done the procedure before, according to Dr. Chen, and all were all able to learn it effectively.

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