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Updated: Oct 21, 2025
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Prognostic value of myocardial perfusion imaging after first-line coronary computed tomography angiography: A
Simon Winther1, Ina Trolle Andersen2, Lars Christian Gormsen3
1Department of Cardiology, Hospital Unit West, Herning, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.
Insights
Myocardial perfusion imaging (MPI) after coronary computed tomography angiography (CTA) helps identify patients at low risk for future cardiac events. MPI can potentially serve as a gatekeeper for invasive coronary angiography (ICA) following CTA.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Preventive Cardiology
Background:
- Coronary computed tomography angiography (CTA) is used to assess coronary stenosis.
- Further diagnostic testing may be needed after CTA to determine prognosis.
- The role of myocardial perfusion imaging (MPI) after CTA is debated.
Purpose of the Study:
- To evaluate the prognostic value of MPI in patients who have undergone CTA.
- To assess if MPI provides additional prognostic information beyond CTA.
- To analyze real-world data on diagnostic work-up following CTA.
Main Methods:
- A 10-year retrospective analysis of patients undergoing first-time CTA for angina symptoms.
- Follow-up duration was a median of 3.7 years.
- Primary endpoint: composite of myocardial infarction or death. Secondary endpoint: late revascularization.
Main Results:
- 53,351 patients underwent CTA; 24% had further testing (7% MPI, 17% ICA).
- Hazard ratios for primary endpoint: 1.37 (medical), 1.68 (MPI), 1.94 (ICA) vs. normal CTA.
- Hazard ratios for secondary endpoint: 2.50 (medical), 6.13 (MPI), 9.18 (ICA) vs. normal CTA.
Conclusions:
- Second-line MPI testing after CTA appears to identify patients at low risk of future cardiac events.
- MPI shows potential as a gatekeeper, guiding decisions for invasive coronary angiography (ICA).
- Stratified analysis indicated similar outcomes for medically treated patients post-CTA and post-MPI.
Purpose:
Further diagnostic testing may be required after a coronary computed tomography angiography (CTA) showing suspected coronary stenosis. Whether myocardial perfusion imaging (MPI) provides further prognostic information post-CTA remains debated. We evaluated the prognosis for patients completing CTA stratified for post-CTA diagnostic work-up using real-world data.
Methods:
We identified all patients in our uptake area with angina symptoms undergoing first-time CTA over a 10-year period. Follow-up time was a median of 3.7 years [1.9-5.8]. The primary endpoint was a composite of myocardial infarction or death. The secondary endpoint was late revascularization.
Results:
During the study period 53,351 patients underwent CTA. Of these, 24% were referred for further down-stream testing, 3,547 (7%) to MPI and 9,135 (17%) to invasive coronary angiography (ICA). The primary and secondary endpoints occurred in 2,026 (3.8%) and 954 (1.8%) patients. Patient-characteristic-adjusted hazard ratios for the primary and secondary endpoint using patients with a normal CTA as reference were 1.37 (1.21-1.55) and 2.50 (1.93-3.23) for patient treated medically, 1.68 (1.39-2.03) and 6.13 (4.58-8.21) for patients referred to MPI and 1.94 (1.69-2.23) and 9.18 (7.16-11.78) for patients referred for ICA, respectively. Adjusted analysis with stratification for disease severity at CTA showed similar hazard ratios for patients treated medically after CTA and patients referred for MPI and treated medically after the MPI.
Conclusion:
In patients completing coronary CTA, second-line MPI testing seems to identify patients at low risk of future events. MPI seems to have the potential to act as gatekeeper for ICA after coronary CTA.
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