Population-level trends in non-invasive cardiac imaging before coronary revascularization

Purpose Non-invasive cardiac testing plays a critical role in evaluating patients for coronary revascularization, yet comprehensive population-level data on utilization patterns and demographic disparities remain limited. We sought to characterize trends in non-invasive cardiac testing among patients undergoing coronary revascularization and examine variations across demographic subgroups. Methods We conducted a retrospective cohort study using the TriNetX Research Network spanning January 2016 through December 2024. The study population comprised 554,855 adults aged 18-90 years who underwent percutaneous coronary intervention or coronary artery bypass grafting at 75 healthcare organizations. We analyzed utilization trends for stress echocardiography, cardiac CT angiography (CCTA), cardiac magnetic resonance imaging (CMR), single-photon emission computed tomography (SPECT), and positron emission tomography (PET), stratified by demographics. Results SPECT remained the predominant modality, with incidence proportion increasing from 3.5% to 5.7%. CCTA increased five-fold (0.46% to 2.18%), CMR nearly tripled (0.27% to 0.79%), and PET increased five-fold (0.14% to 0.70%). Stress echocardiography declined 26% (1.19% to 0.88%). Females showed higher SPECT (6.2% vs. 5.5%) and CCTA (2.31% vs. 2.12%) incidence proportions, while males had higher CMR incidence proportion (0.82% vs. 0.72%). CMR was highest in younger patients (58.82% in adolescents), while SPECT predominated in older patients (5.7-6.0% ages 65-79). SPECT utilization was lowest in Asian patients (3.36% vs. 6.22% in White patients), while CMR was highest in Black patients (1.07% vs. 0.79% in White patients). Conclusions Non-invasive cardiac imaging evolved substantially from 2016 to 2024 within the context of pre-procedural revascularization planning, with growth in advanced modalities. Demographic disparities exhibited modality-specific patterns, underscoring the need for targeted interventions.