Anatomic or Functional Evaluation as an Initial Test for Stable Coronary Artery Disease: A Propensity Score Analysis

Area of Science:

• Cardiology
• Diagnostic Imaging
• Public Health

Background:

• Limited data exist comparing clinical outcomes of initial diagnostic tests for stable coronary artery disease (CAD).
• Coronary angiography (CAG) and myocardial perfusion imaging (MPI) are commonly used initial evaluations for stable CAD.
• Understanding the comparative clinical implications of CAG versus MPI is crucial for patient management.

Purpose of the Study:

• To compare the clinical outcomes of coronary angiography (CAG) versus myocardial perfusion imaging (MPI) as an initial diagnostic evaluation for stable coronary artery disease (CAD).

Main Methods:

• A retrospective study using national health insurance claims data from South Korea (2009-2013).
• Patients (aged ≥18) without prior CAD history undergoing initial CAG or MPI were included (CAG n=117,134; MPI n=19,932).
• Propensity score analysis was used to compare the primary endpoint (all-cause death and myocardial infarction) between the groups.

Main Results:

• Coronary revascularization was significantly more frequent in the CAG group (aHR, 24.15).
• The primary endpoint incidence was significantly higher in the CAG group (aHR, 1.26).
• Individual endpoints of death (aHR, 1.16) and myocardial infarction (aHR, 1.95) were also significantly higher in the CAG group.

Conclusions:

• Myocardial perfusion imaging (MPI) is associated with better clinical outcomes compared to coronary angiography (CAG) when used as an initial diagnostic test for stable CAD.
• MPI may be a preferred initial diagnostic strategy for patients with stable CAD to improve clinical outcomes.
• Further research may explore the mechanisms behind these outcome differences.