Related Experiment Video
Updated: Jul 30, 2025
Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
Characteristics and key differences between patient populations receiving imaging modalities for coronary artery
Matthieu Pelletier-Galarneau1, Emily Vandenbroucke2, Minyi Lu2
1Department of Medical Imaging, Montreal Heart Institute, Montreal, QC, H1T 1C8, Canada. Matthieu.Pelletier-Galarneau@icm-mhi.org.
Insights
Physician referrals for coronary artery disease (CAD) risk assessment heavily favored single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) and stress echocardiography over positron emission tomography (PET) MPI and coronary computed tomography angiography (cCTA). Patients undergoing cCTA were more likely to have repeat imaging tests.
Area of Science:
- Cardiology
- Medical Imaging
- Health Services Research
Background:
- Limited data exists on how imaging modality choice for coronary artery disease (CAD) risk impacts healthcare resource utilization.
- Understanding patient population differences and physician referral patterns across various CAD diagnostic imaging tests is crucial.
Purpose of the Study:
- To compare patient populations undergoing stress echocardiography, SPECT MPI, PET MPI, and cCTA for CAD risk assessment in the US.
- To analyze associated physician referral patterns for these imaging modalities.
Main Methods:
- Analysis of claims and electronic health records for 2.5 million US patients from January 2016 to March 2018.
- Stratification of patients by suspected/existing CAD, pre-test risk, and recent cardiac events.
- Use of linear and logistic regression to compare patient characteristics and referral data.
Main Results:
- Physicians predominantly referred patients to SPECT MPI (77%) and stress echocardiography (18%), with minimal referrals to PET MPI (3%) and cCTA (2%).
- A significant majority of physicians (43%) exclusively referred patients to SPECT MPI.
- Patients undergoing cCTA were more likely to require subsequent imaging tests compared to those undergoing other modalities.
Conclusions:
- SPECT MPI and stress echocardiography are the most frequently utilized imaging modalities for CAD risk assessment, with SPECT MPI being the dominant choice.
- Patients undergoing cCTA may experience higher downstream resource utilization due to a greater likelihood of requiring additional imaging tests.
- Further research is needed to elucidate the factors driving the selection of specific imaging tests for CAD risk assessment across diverse patient groups.
Background:
There are limited data on the impact of imaging modality selection for the assessment of coronary artery disease (CAD) risk on downstream resource utilisation. This study sought to identify differences between patient populations in the US undergoing stress echocardiography, single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), positron emission tomography (PET) MPI, and coronary computed tomography angiography (cCTA) for the assessment of CAD risk, and associated physician referral patterns.
Methods:
Claims and electronic health records data for 2.5 million US patients who received stress echocardiography, cCTA, SPECT MPI or PET MPI between January 2016 and March 2018, from the Decision Resources Group Real-World Evidence US Data Repository, were analysed. Patients were stratified into suspected and existing CAD cohorts, and further stratified by pre-test risk and presence and recency of interventions or acute cardiac events (within 1-2 years pre-index test). Linear and logistic regression were used to compare numeric and categorical variables.
Results:
Physicians were more likely to refer patients to standalone SPECT MPI (77%) and stress echocardiography (18%) than PET MPI (3%) and cCTA (2%). Overall, 43% of physicians referred more than 90% of their patients to standalone SPECT MPI. Just 3%, 1% and 1% of physicians referred more than 90% of their patients to stress echocardiography, PET MPI or cCTA. At the aggregated imaging level, patients who underwent stress echocardiography or cCTA had similar comorbidity profiles. Comorbidity profiles were also similar for patients who underwent SPECT MPI and PET MPI.
Conclusion:
Most patients underwent SPECT MPI at the index date, with very few undergoing PET MPI or cCTA. Patients who underwent cCTA at the index date were more likely to undergo additional imaging tests compared with those who underwent other imaging modalities. Further evidence is needed to understand factors influencing imaging test selection across patient populations.
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