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Updated: Apr 16, 2026
Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
Population-level trends in non-invasive cardiac imaging before coronary revascularization
Reuben L Odai1,2, Dennis Tsagli3, Ibrahim Touffaha4
1Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS, USA. rodai@kumc.edu.
Insights
Non-invasive cardiac testing for revascularization planning saw significant shifts from 2016-2024, with advanced imaging growing. Utilization varied by patient demographics, highlighting disparities in cardiac CT angiography (CCTA), cardiac magnetic resonance imaging (CMR), and single-photon emission computed tomography (SPECT).
Area of Science:
- Cardiology
- Medical Imaging
- Health Services Research
Background:
- Non-invasive cardiac testing is crucial for coronary revascularization decisions.
- Limited data exists on population-level utilization trends and demographic disparities in these tests.
- Understanding these patterns is key to equitable healthcare delivery.
Purpose of the Study:
- To analyze trends in non-invasive cardiac testing utilization among patients undergoing coronary revascularization.
- To investigate demographic variations in the use of different cardiac imaging modalities.
Main Methods:
- Retrospective cohort study using the TriNetX Research Network (2016-2024).
- Included 554,855 adults undergoing percutaneous coronary intervention or coronary artery bypass grafting.
- Analyzed utilization of stress echocardiography, CCTA, CMR, SPECT, and PET, stratified by demographics.
Main Results:
- SPECT remained dominant, but CCTA, CMR, and PET use increased significantly; stress echocardiography use declined.
- Demographic disparities were observed: females had higher SPECT/CCTA use, males higher CMR use.
- Age and race influenced modality choice, with SPECT favored in older and White patients, and CMR in younger and Black patients.
Conclusions:
- Non-invasive cardiac imaging for revascularization planning evolved with increased use of advanced modalities.
- Significant demographic disparities exist, varying by imaging technique.
- Targeted interventions are needed to address these modality-specific disparities.
Abstract:
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.
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